甲泼尼龙联合丙种球蛋白治疗川崎病疗效观察

Effect of methylprednisolone combined with gamma globulin in the treatment of Kawasaki disease

目的探讨甲泼尼龙联合丙种球蛋白治疗小儿川崎病的临床效果。方法选择2016年1月至2017年12月江阴市中医院收治的川崎病患儿70例为研究对象,根据治疗方法将患者分为观察组和对照组,每组35例。2组患儿均给予阿司匹林50 mg·kg^(-1)·d^(-1),口服;丙种球蛋白2 g·kg^(-1)·d^(-1),静脉注射,连用14 d;在此治疗基础上,观察组患儿给予甲泼尼龙琥珀酸钠2 mg·kg^(-1)·d^(-1),静脉注射,第1~5天;然后给予甲泼尼龙片2 mg·kg^(-1)·d^(-1),口服,连用14 d。记录2组患儿临床症状消失时间、住院时间及不良反应;分别于治疗前及治疗后第7天检测2组患儿白细胞计数(WBC)、红细胞沉降率(ESR)及血清C反应蛋白(CRP)水平。结果观察组患儿发热、淋巴结大、黏膜充血、手足硬性水肿的消失时间及住院时间显著短于对照组(P<0.05);治疗前2组患儿WBC、ESR及血清CRP水平比较差异均无统计学意义(P>0.05),2组患儿治疗后WBC、ESR及血清CRP水平显著低于治疗前(P<0.05);治疗后,观察组患儿WBC、ESR及血清CRP水平显著低于对照组(P<0.05)。观察组和对照组患儿不良反应发生率分别为5.71%(2/35)、2.86%(1/35),2组患儿不良反应发生率比较差异无统计学意义(χ~2=0.001,P>0.05)。结论甲泼尼龙联合丙种球蛋白能快速缓解川崎病患儿的临床症状,减轻患儿炎症反应,且在严格控制甲泼尼龙剂量的情况下,不良反应较轻。

Objective To investigate the effect of methylprednisolone combined with gamma globulin in the treatment of Kawasaki disease.Methods Seventy children with Kawasaki disease in Jiangyin Hospital of Traditional Chinese Medicine from January 2016 to December 2017 were selected as the subjects.The patients were divided into observation group and control group according to the treatment method,thirty-five cases in each group.The patients in the two groups were treated with aspirin 50 mg·kg^-1 ·d^-1 by oral and gamma globulin 2 g·kg^-1 ·d^-1 by intravenous injection for 14 days.On the basis of this treatment,the patients in the observation group were treated with methylprednisolone hemisuccinate 2 mg·kg^-1 ·d^-1 by intravenous injection from the first to the fifth day,then the patients in the observation group were treated with methylprednisolone tablets 2 mg·kg^-1 ·d^-1 by oral for 14 days.The clinical symptoms extinction time,hospitalization time and adverse reactions of the patients in the two groups were recorded.Leukocyte count（WBC）,erythrocyte sedimentation rate（ESR） and serum C-reactive protein（CRP） level were detected before and at seven days after treatment.Results The hospitalization time and the extinction time of fever,lymphadenectasis,mucosal congestion,rigid edema of hand and foot in the observation group were significantly shorter than those in the control group（ P 〈0.05）.There was no significant difference in the levels of WBC,ESR and serum CRP between the two groups before treatment（ P 〉0.05）.The levels of WBC,ESR and serum CRP after treatment were significantly lower than those before treatment in the two groups（ P 〈0.05）.The levels of WBC,ESR and serum CRP in the observation group were significantly lower than those in the control group after treatment（ P 〈0.05）.The incidence of adverse reactions in the observation group and the control group was 5.71%（2/35） and 2.86%（1/35） respectively,there was no significant difference in the incidence of adverse reactions between the two groups（ χ^2=0.001, P 〉0.05）.Conclusion Methylprednisolone combined with gamma globulin can rapidly relieve the clinical symptoms and alleviate inflammation of children with Kawasaki disease.The adverse reactions are mild when the dosage of methylprednisolone was strictly controlled.