不同剂量免疫球蛋白治疗小儿川崎病的临床分析

Therapeutic effects of different doses of immunoglobulin on Kawasaki disease in children

目的分析不同剂量免疫球蛋白治疗小儿川崎病的临床效果。方法选取2016年1~8月接受治疗的小儿川崎病患者64例,根据治疗剂量分为A组和B组,每组32例。A组、B组分别给予1 g/kg、2 g/kg免疫球蛋白单次静脉注射治疗。记录2组患者症状消退时间、冠状动脉病变发生情况、血清基质金属蛋白酶含量[基质金属蛋白酶-2(MMP-2)、基质金属蛋白酶-9(MMP-9)]及实验室检查[白细胞计数(WBC)、C-反应蛋白(CRP)、纤维蛋白原(FIB)、血沉(ESR)、IgG、IgM、IgA、CD_3、CD_4、CD_8、CD_4/CD_8],并进行统计学分析。结果 2组患者皮疹、结膜炎、淋巴结肿大等症状消退时间比较差异无统计学意义(P>0.05)。2组治疗后2、4、8、12周冠状动脉病变发生率差异无统计学意义(P>0.05)。2组患者治疗后血清MMP-2及MMP-9较治疗前均有所下降,且B组下降更为明显,差异有统计学意义(P<0.05)。2组患者经治疗后,实验室检查指标均得到有效改善,B组CRP、ESR及Ig G等指标改善更为明显,差异有统计学意义(P<0.05)。结论 1 g/kg及2 g/kg免疫球蛋白治疗小儿川崎病均能有效缓解患儿症状,缩短病程,降低冠状动脉病变发生率,2 g/kg免疫球蛋白治疗效果更加突出,临床上值得推广。

Objective To investigate the therapeutic effects of different doses of immunoglobulin on Kawasaki disease in children. Methods Sixty children patients with Kawasaki disease who were treated in our hospital from January 2016 to August 2016 were divided into group A and group B according to different doses of immunoglobulin. The 32 patients in group A were given immunoglobulin 1 g/kg,however,the other 32 patients in group B were given immunoglobulin 2 g/kg. The regression time of patient＇s symptoms,incidence rates of coronary artery disease,the serum levels of serum matrix metalloproteinase（ MMP-2 and MMP-9） and laboratory examination indexes were statistically analyzed and compared between the two groups.Results After treatment,there were no significant differences in the regression time of skin rash,conjunctivitis and lymph node enlargement between two groups（ P〉0. 05）,moreover there were no significant differences in incidence rates of coronary artery lesions between two groups（ P〉0. 05）. However the serum levels of MMP-2 and MMP-9 were decreased in both groups,as compared with those before treatment,moreover,the decrease degree in group B was more obvious than that in group A（ P〈0. 05）. After treatment,the laboratory examination indexes were improved in both groups,but the improvement degree of CRP,ESR and Ig G in group B was more significant than that in group A（ P〈0. 05）. Conclusion The immunoglobulin at the doses of 1 g/kg and 2 g/kg can effectively relieve the symptoms of children patients with Kawasaki disease,and can shorten disease course and reduce the incidence rates of coronary artery lesions, however, the immunoglobulin 2 g/kg has more obvious therapeutic effects on Kawasaki disease,therefor,which is worth using widely in clinical practice.