低分子肝素辅助治疗川崎病高凝状态对患儿血管炎症及冠脉损害的改善作用

Effect of Low Molecular Weight Heparin to Vascular Inflammation and Coronary Artery Lesion in Kawasaki Disease Combined with Hypercoagulability

目的:探讨低分子肝素用于辅助治疗川崎病高凝状态的价值。方法:选择我院2014年1月至2017年1月确诊的川崎病高凝状态住院患儿共102例,按是否接受低分子肝素治疗,分为观察组55例和对照组47例。观察组在丙种球蛋白及阿司匹林治疗基础上加用低分子肝素治疗,对照组仅给予丙种球蛋白及阿司匹林治疗。治疗前后监测患儿凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶原国际标准化比值(INR)、纤维蛋白原(FIB)、D-二聚体水平、血沉(ESR)、血小板计数(PLT)、红细胞压积(HCT)、高敏C反应蛋白(hs-CRP)的变化。出院后随访6个月,心脏彩超观察冠脉损害情况。结果:治疗前两组患儿血管炎症指标比较差异均无统计学意义(P均>0.05);治疗后两组患儿的PLT、HCT、hs-CRP、ESR、FIB、D-二聚体均下降(P均<0.05),且观察组PLT、hs-CRP、ESR、FIB、D-二聚体水平低于对照组(P均<0.05)。两组患儿均未出现明显出血倾向情况,观察组冠脉损害发生率16.36%,低于对照组的34.04%(P<0.05)。结论:低分子肝素作为川崎病高凝状态患儿的辅助治疗,在降低血小板、抗炎、改善高凝状态、减少冠脉损害方面具有一定临床应用价值。

Objective： To investigate the value of low molecular weight heparin in Kawasaki disease combined with hypercoagulability. Methods： There were 102 cases, of which 55 cases had been treated with IVIG, aspirin and low molecular heparin as observation group, 47 cases treated with IVIG and aspirin as control group. The changes of PT, APTT, INR, FIB, D-dimmer, ESR, PLT, HCT, and hs-CRP were monitored, and the discharged children were followed up for 6 months, the coronary arteries lesion was observed by cardiac color ultrasound. Results： Before treatment, the comparison differences of vascular inflammation indexes were not statistically meaningful （P〉0. 05）. After treatment, PLT, HCT, hs-CRP, D dimmer, ESR, and FIB in observation group were significantly lower than control group （ P〈0. 05 ）. The two groups had no obvious bleeding tendency, and the coronary arteries lesion incidence rate of the observation group （16. 36% ） was lower than that of the control group （34. 04% ） （P〈0. 05 ）. Conclusion： Low molecular weight heparin is effective and safe in treatment of Kawasaki disease combined with hypereoagulability.