不同方案初次治疗川崎病的疗效观察

Effect observation of different methods on initial treatment of Kawasaki disease

目的探讨不同方案初次治疗川崎病(KD)的疗效。方法 124例典型川崎病患儿根据病情分别给予4种治疗方案。A组给予IVIG 2 g/kg治疗;B组给予甲基强的松龙+乌司他丁治疗;C组给予IVIG+乌司他丁治疗;D组给予IVIG+甲基强的松龙治疗。观察初次治疗后各组患儿体温及冠状动脉的变化情况。结果 A组52例患儿(81.25%)治疗后体温在48 h内正常,3例(4.76%)出现冠脉瘤(CAA)。B组所有患儿体温均在48 h内正常,7例(15.56%)治疗后出现CAA。随访3月,A组与B组治疗方案对患儿发生CAA的风险无显著差异(P>0.05)。C组7例患儿治疗后48 h内体温均正常。D组6例(75%)患儿在治疗后48 h内体温正常,未发生冠脉扩张。结论甲基强的松龙联合乌司他丁治疗川崎病能更好地控制体温,且治疗后发生冠脉损害的风险与IVIG方案相比无显著差异。

Objective To explore clinical efficacy of different methods in initial treatment of Kawasaki disease（KD）. Methods One hundred and twenty-four patients with typical Kawasaki disease were given four treatment therapies based on their diseases condition. Patients in group A were treated with IVIG of 2 g / kg. Group B was treated with intravenous methylprednisolone plus ulinastatin.Group C was treated with IVIG plus ulinastatin. Group D was treated with IVIG plus methylprednisolone. After the initial treatment,temperature and coronary artery was observed. Results Body temperature of 52 patients（81. 25%） in group A returned to normal within 48 hours,and 3 patients（4.76%） developed coronary artery neurysm（CAA）. Body temperature of all patients in group B became normal within 48 hours after the initial therapy and 7 patients（15. 56%） developed CAA after treatment. There was no significant difference in the risk of CAA between group A and group B after 3months follow-up（P〉 0. 05）. A total of 7 patients in group C returned to normal body temperature within 48 hours. A total of 6 patients（75%） in group D returned to normal body temperature within 48 hours without CAA occurrence. Conclusion Methylprednisolone combined with ulinastatin can effectively control the body temperature. Compared with IVIG therapy,there is no significant different in risk of CAA.