丙种球蛋白对不同病程川崎病疗效及其冠状动脉病变并发症的影响

Effects of Gamma Globulin on Different Courses of Kawasaki Disease and Coronary Artery Involvement

目的探讨静脉注射丙种球蛋白对不同病程川崎病疗效及其冠状动脉病变并发症的影响。方法将64例川崎病患儿按不同病程分为3组:A组(病程≤5d)18例、B组(病程6~9d)21例、C组(病程≥10d)25例,3组患儿均大剂量静脉滴注丙种球蛋白,单次注射剂量为2g·kg^(-1)。比较3组患儿治疗前后血常规指标(红细胞沉降率、血小板计数)的变化情况及治疗后丙种球蛋白无反应性发生率、冠状动脉病变并发症发生率。结果 3组患儿治疗前后红细胞沉降率及血小板计数比较差异均无统计学意义(P>0.05);3组患儿治疗后红细胞沉降率及血小板计数与治疗前相比均显著降低(P=0.000)。丙种球蛋白无反应性发生率A组显著高于B组、B组显著高于C组,3组丙种球蛋白无反应性发生率比较差异有统计学意义(P<0.05);冠状动脉病变并发症发生率C组显著高于B组、B组显著高于A组,3组冠状动脉病变并发症发生率比较差异有统计学意义(P<0.05)。结论川崎病患儿最佳治疗方案为病程6~9d时大剂量应用丙种球蛋白,在此阶段,可以缩短临床症状的显现时间,治疗效果较好。

Objective To investigate the effects of intravenous injection of gamma globulin on different courses of Kawasaki disease and coronary artery involvement.Methods Sixty-four children with Kawasaki disease were divided into three groups：group A（disease course≤5 day,18 children）,group B（disease course 6-9day,21 children）,and group C（disease course≥10 day,25 children）.All children were treated with high-dose intravenous gamma globulin（2g·kg^-1 per time）.The erythrocyte sedimentation rate and platelet count were measured before and after the treatment.Furthermore,the incidence of non-responsiveness and coronary artery disease was recorded after treatment.Results There were no significant difference in erythrocyte sedimentation rate and platelet count among the three groups before treatment（P〈0.05）.However,the treatment with gamma globulin significantly decreased erythrocyte sedimentation rate and platelet count in all the three groups（P=0.000）.The incidence of non-responsiveness to gamma globulin in group A was higher than that in group B,and that in group B was higher than that in group C（P〈0.05）.The incidence of coronary artery disease in group C was higher than that in group B,and that in group B was higher than that in group A（P〈0.05）.Conclusion The treatment with high-dose gamma globulin during 6-9 days of disease course is the optimal therapeutic regimen for Kawasaki disease,which can shorten the appearance time of clinical symptoms.