皮肤黏膜淋巴结综合征56例临床分析

Clinical Analysis of 56 Patients with Kawasaki Disease

目的探讨大剂量静脉丙种球蛋白治疗皮肤黏膜淋巴结综合征(川崎病)的疗效及与冠状动脉病变的关系。方法选取2006年1月-2008年12月期间住院的川崎病患儿56例。随机分为两组:治疗组采用一次大剂量(2 g/kg)静脉输注丙种球蛋白,对照组给予小剂量丙种球蛋白[400 mg/(kg.d)],1次/d,连用5 d。两组同时口服阿司匹林,急性期30～50 mg/(kg.d),热退后改为3～5 mg/(kg.d)。服用至血沉、血小板正常、无冠状病变后停药。结果治疗组24 h内体温下降者24例,72 h内退热者5例,>72 h者1例。对照组24 h内体温下降者3例,72 h内退热者15例,>72h者8例,其中3例于退热后再次发热。两组疗效比较差异有统计学意义(P<0.05)。两组患儿治疗后1周血白细胞均有下降,1个月后血小板、心电图大部分正常;治疗组出院后1个月时复查有2例发现冠状动脉损害,其中1例于3个月时消失,1例于6个月时消失。对照组出院后1个月时有4例发现冠状动脉损害,其中2例于12个月时消失,2例于24个月时消失。结论早期大剂量单次静脉输注丙种球蛋白对缓解川崎病的急性期症状及预防或减少冠状动脉损害起重要作用。而且未发现明显不良反应。

Objective To explored the clinical effects of large dose of ctype immunoglobulin intravenous on the mucocutane ous lymph node syndrome （ Kawasaki disease）, and the relationship with coronary artery pathological changes. Methods Fifty six cases with Kawasaki disease selected from January 2006 to December 2008 were randomly divided into two groups. Treatment group adopted with large doses（2 g/kg） ctype immunoglobulin intravenous infusion, while the control group adopted with small doses [ 400 mg/（ kg . d） ] ctype immunoglobulin. Once a day, construes 5 days. Two groups of patients were oral aspirin, acute phase 30 50 mg/（ kg . d）, after heat back changed 3 5 mg/（ kg . d）. The drugs were cancelled after ESR and platelet turning out normal and without coronary disease. Results Treatment group ：24 cases temperaturedropping were within 24 h,5 cases with in 72 h, 1 case greater than 72 h. Control group ：3 cases temperaturedropping were within 24 h, 15 cases within 72 h,8 cases grea ter than 72 h. 3 patients got a fever again after antifebrile. The differences were statistically significant between two groups （ P 〈 0.05 ）. After one week of treatment, the white blood count of patients in both groups decreased. After one month, the platelet count and electrocardiogram recovered normal in most patients. Two patients of treatment group had coronary artery damage in one month. One case disappeared in three month, the other one disappeared in six month. Four patients of control group had coronary artery damage in one month. And two cases still did not disappear in twelve month. Conclusion The effect of early single high dose intravenous ctype immunoglobulin was better than that of small doses. It can effectively relive the symptoms in acute phase of Kawasaki disease and prevent or reduce coronary damage,with few adverse reactions.