| 157 | 4 | 10 |
| 下载次数 | 被引频次 | 阅读次数 |
目的探讨给予3种不同方案治疗川崎病(KD)的临床效果。方法采用非随机临床对照研究的方法,选择2011年1月-2013年12月新疆乌鲁木齐儿童医院收住院诊断为KD的118例患儿,根据入院时病情在给予阿司匹林的基础治疗上,分别给予3种治疗方案,根据患者家属选择治疗方案的不同分为A、B、C组。A组(64例)给予静脉人血丙种球蛋白(IVIG)2.0g/kg标准治疗;B组(45例)给予静脉注射甲基强的松龙(IVMP)+乌司他丁治疗;C组(9例)给予IVIG 2g/kg+乌司他丁治疗。比较3组患者在初次治疗24、48h体温正常的例数、二次再治疗的比例以及治疗后1w、3个月、6个月冠状动脉内径的变化。结果 3组患儿治疗24h退热的比例以B组最高(93.33%),C组次之(77.77%),A组最低(70.31%);治疗48h后B、C组患儿体温降至正常,A组有12例(18.75%)仍发热,为耐药KD;3组患儿退热效果以B组最好,差异具有统计学意义(P<0.05)。A组与B组患儿在治疗前、治疗后1w、3及6个月冠状动脉内径差异无统计学意义(P>0.05)。二次再治疗的比例以A组最高(12例,18.75%),B组次之(2例,4.44%),C组无二次再治疗病例。结论甲基强的松龙+乌司他丁治疗方案与IVIG治疗方案相比在川崎病急性期能更好地控制体温,缩短发热时间,减轻炎症反应,治疗后未增加发生冠状动脉损害的风险;IVIG+乌斯他定治疗方案对冠状动脉瘤的恢复有一定的促进作用。
Abstract：Objective To investigate the clinical efficacy of three different therapeutic schemes for Kawasaki disease(KD).Methods A non-randomized study method was adopted to treat 118 children with KD during 2011.1.1-2013.12.31.With oral aspirin as the basic treatment for KD,these patients were divided into three groups:64patients in group A were treated with intravenos immunoglobulin(IVIG)2g/kg as the standard treatment;45patients in group B treated with intravenous methylprednisolone(IVMP)combined with intravenous ulinastatin;9patients in group C with intravenous immunoglobulin(IVIG)2g/kg combined with intravenous ulinastatin.The data of patients with normal temperatures in 3groups in 24or48 hours after the initial treatment and the ratio of second course of treatment were collected and compared with the diameter of the coronary artery in 1week,3months and 6months after the treatment.ResultsGroup B ranked highest(93.33%)in the defervescence ratio in 3groups in 24 hours after the treatment,with Group C the second(77.77%)and Group A the lowest one(70.31%).All patients in Group B and C had no fever in 48 hours after the treatment,12 patients in group A(18.75%)were considered to be drugresistant KD,for their temperatures didn′t return to normal in 48 hours after the treatment.Group B had the best antipyretic effect with statistical difference(P <0.05)among the three groups.There is no statistical difference between Group A and Group B on the diameter of the coronary artery before the treatment and in 1week,3months,and 6months after the treatment(P >0.05).12 patients in group A(18.75%)and 2patients in group B(4.44%)received second course of treatment while no patients in group C received second course of treatment.Conclusion Compared with standard IVIG treatment,Methylprednisolone and ulinastatin treatment for Kawasaki disease in the acute phase can better control the temperature,shorten the fever duration and reduce inflammation,with no risk of coronary artery aneurysm.IVIG treatment combined with ulinastatin had better effects than the individual IVIG treatment.
[1]Fury W,Tremoulet AH,Watson VE,et al.Transcript abundance patterns in Kawasaki disease patients with intravenous immunoglobulin resistance[J].Hum Immunol,2010,71(9):865-873.
[2]Nakamum Y,Yashiro M,Uehara R,et al.Epidemiologic features of Kawasaki disease in japan:Resuits of the 2009-2010nationwide survey[J].J Epidemiol,2012,22(3):216-221.
[3]Prieto TL,Cuesta RM,Guillen Ms,et al.Kawasaki disease:diagnosis and treatment[J].Ann Pediatr(Barc),2010,73(1):25-30.
[4]张敏,胡秀芬.丙种球蛋白无反应型川崎病研究进展[J].中华实用儿科杂志,2013,28(21):1672-1676.
[5]Freemman AF,Shulman ST.Refractory Kawasaki disease[J].Pediatr Infect Dis J,2004,23:463-464.
[6]Jibiki T,Kato I,Shiohama T,et al.Intravenous immune globulin plus corticosteroids in refractory Kawasaki diseas[J].Pedio Int,2011,53(5):729-735.
[7]Suzuki H,Terai M,Hamada H,et al.Cyclosporin a treatment for Kawasaki disease refractory to initialand additional intravenous immunoglobulin[J].Pediatr Intfect Dis J,2011,30(10):871-876.
[8]Ravelli A,Magni-Manzoni S,Pistorio A,et al.Preliminary diagnosis guidelines for macrophage activation syndrome complicating systemic juvenile idiopathic arthritis[J].J Pediatr,2005,146;598-604.
[9]Athappan G,Gale S,Ponniab T.Corticosteroid therapy for primary treatment of Kawasaki disease-weight of evidence:A meta-analysis and systematic review of the literature[J].Cardiovasc J Afr,2009,20(4):233-236.
[10]胡亚美,江载芳.实用儿科学[M].7版.北京:人民卫生出版社,2002:689-705.
[11]Daniels LB,Tjajadi MS,Walford HH,et al.Prevalence of Kawasaki disease in young adults with suspected myocardia ischemia[J].Circulation,2012,125(20):2447-2453.
[12]Muta H,Ishii M,Iemura M,et al.Health-related quality of life in adolescents and young adults with history of Kawasaki disease[J].J Pediatr,2010,156(3):439-443.
[13]刘芳.川崎病的病因及发病机制研究进展[J].实用儿科临床杂志,2011,26(21):1671-1618.
[14]Rowley AH,Shulman ST.Pathogenesis and management of Kawasaki disease[J].Expert Rev Anti Infect Ther,2010,8(2):197-203.
[15]汪云,马官福,伏瑾,等.川崎病患儿血清白细胞介素-6、白细胞介素-8水平变化及其冠状动脉损伤的关系[J].实用儿科临床杂志,2010,25(9):632-633.
[16]Caleoti C,Bayry J,Kone-Paut I,et al.Kawasaki disease:aetiopathogenesis and therapeutic utility of intravenous immunoglobulin[J].Autoimmun Reu,2010,9(6):441-448.
[17]张晓梅,孙景辉.川崎病诊治进展[J].实用儿科临床杂志,2011,26(1):52-55.
[18]Kobayashi T,Kobayashi T,Morikawa A,et al.Efficacy of intravenous immunoglobulin combined with prednisolone following resistance to initial intravenous immunoglobulin treatment of acute kawasaki disease[J].J Pediatr,2013,163(2):521-526.
[19]Miura M,Tamame T,Naganuma T,et al.Stemid pulse therapy for Kawasaki disease unresponsive to additional immunoglobulin therapy[J].Pediatr Child Health,2011,16(8):479-484.
[20]Shinohara M,Sone K,Tomomasa T,ed al.Corticosteroids in the treatment of the acute phase of Kawasaki disease[J].J Pediatr,1999,135(4):465-469.
[21]Sundel RP,Baker AL,Fulton DR,et al.Corticosteroids in the initial treatment of Kawasaki disease:report of a randomized trial[J].J Pediatr,2003,142(6):611-616.
[22]Leung DWM,Schlievert,PM,Meissner HC.The immunopathogenesis and management of Kawasaki syndrom[J].Arthritis Rheum,1998,41(9):1538-1547.
[23]陈茂荣,杨运刚.甲基泼尼松龙治疗川崎病的疗效及对冠状动脉影响的探讨[J].临床儿科杂,2006,24(6):520-522.
[24]Kanai T,Ishiwata T,Kobayashi T,et al.Ulinastatin,a urnary trypsin inhibitor,for the initial treatment of patienls with Kawasaki diseas:A retmspective study[J].Circulaion,2011,124(25):2822-2828.
[25]佐地勉.川崎病静脉丙种球蛋白无反应重症病例的治疗对策及临床效果观察.小儿内科,2003,35:1584-1586.
[26]潘晶莹,白玉新,朱华.我国川崎病的流行病学特征[J].国际儿科学杂志,2013,(40):466-469.
[27]张伟,李秋,赵晓东,等.942例川崎病的临床分析[J].中华儿科杂志,2006,44(5):324-328.
[28]杨军,赵晓东,李成荣.静脉注射免疫球蛋白非敏感型川崎病诊疗进展[J].实用儿科临床杂志,2006,21(21):1447-1448.
[29]Genizi J,Miron D,SpiegelR,et al.Kawasaki disease in very young infants:high prevalence of atypical presentation and coronary arteritis[J].Clin Pediatr,2003,42:263-267.
基本信息:
中图分类号:R725.4
引用信息:
[1]赵冬梅,尹千里,米尔扎提·海维尔,等.3种不同方案治疗川崎病的临床疗效分析[J].新疆医科大学学报,2014,37(12):1638-1642.
基金信息:
新疆乌鲁木齐市科技局科研项目(Y111310022)
2014-12-15
2014-12-15