不同途径给予激素治疗丙种球蛋白无反应型川崎病临床观察

Clinical Observation of Different Ways of Hormone Therapy in Treatment of Patients with Gamma Globulin Non-responsive Kawasaki Disease

目的探讨不同途径给予激素治疗丙种球蛋白(IVIG)无反应型川崎病(KD)患儿的临床疗效及安全性。方法回顾性分析2012年1月—2015年12月收治的IVIG无反应型KD患儿104例的临床及随访资料,根据激素给予途径的不同分为对照组50例和观察组54例,对照组予以静脉滴注序贯口服激素治疗,观察组予以口服激素治疗。治疗结束后比较2组相关医技检查指标水平和总热程、退热时间及住院时间,并记录2组治疗后随访过程中冠状动脉病变及血栓形成情况。结果 2组总热程、退热所需时间以及住院时间比较差异均无统计学意义(P>0. 05)。治疗后2组血小板均较治疗前升高(P <0. 05)。治疗后观察组C反应蛋白水平低于对照组(P <0. 05)。随访期间不同时间段2组冠状动脉扩张和冠状动脉瘤发生率比较差异无统计学意义(P>0. 05)。观察组未发生血栓,对照组发生4例。结论激素治疗IVIG无反应型KD患儿具有良好的近远期效果,但采用口服途径具有更好的安全性。

Objective To investigate clinical efficacy and safety of different ways of hormone therapy in treatment of patients with intravenous immunoglobulin(IVIG)non-responsive Kawasaki disease.Methods Clinical and follow-up data of 104 children with IVIG non-responsive KD admitted during January 2012 and December 2015 was retrospectively analyzed,and the children were divided into control group(n=50)and observation group(n=54)according to different ways of hormone therapy.Control group was treated with intravenous and sequential hormonal therapy orally,while observation group was treated with hormonal therapy orally.After treatment,levels of related medical examination indexes,total heat duration,pyretolysis time and hospitalization duration were compared,and conditions of coronary artery lesions and thrombosis during follow-up were recorded in two groups.Results There were no significant differences in total heat duration,pyretolysis time and hospitalization duration between two groups(P>0.05).After treatment,platelet(PLT)levels were significantly higher than those before treatment in two groups(P<0.05);C-reactive protein(CRP)level in observation group was significantly lower than that in control group(P>0.05).During follow-up,there were no statistically significant differences in incidence rates of coronary artery dilatation and coronary artery tumor at different times between two groups(P>0.05).There was no thrombus in observation group,and 4 patients had thrombus in control group.Conclusion Hormone therapy in treatment of patients with IVIG non-responsive Kawasaki disease may achieve good short and long-term effect,but oral administration has better safety.