强化抗血小板方案辅助丙种球蛋白对川崎病患儿近期疗效、症状缓解时间及炎性因子指标水平的影响

Influence of intensive antiplatelet scheme assisted with gamma-immunoglobulin on clinical efficacy, the relieve time of clinical symptoms and the levels of inflammatory factors of children with Kawasaki disease

目的探讨强化抗血小板方案辅助丙种球蛋白对川崎病患儿近期疗效、症状缓解时间及炎性因子指标水平的影响。方法研究对象选取浙江省义乌市妇幼保健计划生育服务中心2014年7月~2016年7月收治川崎病患儿共80例,以随机数字表法分为对照组（40例）和观察组（40例）。分别在丙种球蛋白应用基础上给予二联抗血小板（阿司匹林＋双嘧达莫）和三联抗血小板（阿司匹林＋双嘧达莫＋氯吡格雷）方案治疗;比较2组患儿近期疗效,临床症状体征缓解时间,治疗前后WBC、PLT、PCT、CRP、IL-6、TNF-α、HMGB1及MIF水平,冠状动脉损伤发生率及药物不良反应发生率等。结果观察组患儿近期治疗总有效率均显著高于对照组（P〈0.05）;观察组患儿临床症状体征缓解时间显著短于对照组（P〈0.05）;观察组患儿治疗后WBC和PLT水平均显著优于对照组、治疗前（P〈0.05）;观察组患儿治疗后PCT、CRP、IL-6、TNF-α、HMGB1及MIF水平均显著低于对照组、治疗前（P〈0.05）;观察组患儿冠状动脉损伤发生率显著低于对照组（P〈0.05）;同时2组患儿药物不良反应发生率比较差异无统计学意义。结论强化抗血小板方案辅助丙种球蛋白治疗川崎病可有效减轻临床症状体征,控制机体炎症反应水平,抑制血小板聚集,避免冠状动脉损伤出现,且未导致严重药物不良反应发生。

Objective To investigate the influence of intensive antiplatelet scheme assisted with gamma-immunoglobulin on clinical efficacy, the relieve time of clinical symptoms and the levels of inflammatory factors of children with Kawasaki disease.Methods80 children with Kawasaki disease were chosen in the period form July 2014 to July 2016 in Yiwu hospital of Zhejiang province and randomly divided into two groups including the control group （40 cases） with bigeminy scheme including aspirin and dipyridamole and the observation group （40 cases） with trigeminy scheme including aspirin, dipyridamole and clopidogrel on the basis of gamma-globulin;and the clinical efficacy for short-term, the relieve time of clinical symptoms and signs, the the levels of WBC, PLT, PCT, CRP, IL-6, TNF-α, HMGB1 and MIF before and after treatment, the incidence of coronary artery injury and the incidence of adverse drug reactions of both groups were compared.ResultsThe total clinical effects of observation group were significantly higher than control group（P〈0.05）.The relieve time of symptoms and signs of observation group were significantly shorter than control group（P〈0.05）.The levels of WBC and PLT after treatment of observation groups were significantly lower than control group and before treatment（P〈0.05）.The levels of PCT, CRP, IL-6, TNF-α, HMGB1 and MIF after treatment of observation groups were significantly lower than control group and before treatment（P〈0.05）.The incidence of coronary artery injury of observation groups were significantly lower than control group（P〈0.05）.There was no significant difference in the adverse drug effects incidence between 2 groups.ConclusionIntensive antiplatelet scheme assisted with immunoglobulin in the treatment of children with Kawasaki disease can efficiently relieve the respiratory symptoms and signs, control the levels of inflammatory reaction, inhibit the platelet aggregation, prevent the occurrence of coronary artery injury and not cause the serious adverse drug reactions.