糖皮质激素联合乌司他丁治疗川崎病并冠状动脉损伤临床研究

Glucocorticoids Combined with Ulinastatin in the Treatment of Children Patients with Kawasaki Disease Complicated with Coronary Artery Injury

目的探讨糖皮质激素联合乌司他丁治疗川崎病并冠状动脉损伤的临床疗效。方法选取随州市中心医院2014年3月至2019年3月收治的川崎病患儿70例,按随机数字表法分为观察组和对照组,各35例。两组患儿均予基础治疗,对照组患儿初始治疗加用静注人免疫球蛋白(pH4),观察组患儿初始治疗加用注射用甲泼尼龙琥珀酸钠(3 d后改为醋酸泼尼松片)联合注射用乌司他丁。结果观察组患儿发热消退时间显著短于对照组(P<0.05);治疗8周后,两组患儿的冠状动脉Z值显著低于治疗前及治疗后1周(P<0.05);与治疗前比较,两组患儿治疗后1,3周的白细胞计数(WBC)、红细胞沉降率(ESR)、C反应蛋白(CRP)水平均显著降低,血小板计数(PLT)水平显著升高,治疗后3周上述指标显著优于治疗后1周,且观察组患儿治疗后1,3周的WBC显著高于对照组,ESR显著低于对照组(P<0.05);观察组患儿的药品费用、住院总费用均显著少于对照组(P<0.05);观察组与对照组不良反应发生率相当(17.14%比20.00%,χ^2=0.095,P=0.759>0.05)。结论糖皮质激素联合乌司他丁治疗川崎病并冠状动脉损伤,能缩短患儿发热病程,抑制冠脉扩张,利于ESR下降,且能减少药品费用及住院总费用。

Objective To observe the clinical efficacy of glucocorticoids combined with ulinastatin in the treatment of children patients with Kawasaki Disease complicated with coronary artery injury.Methods A total of 70 children patients with Kawasaki Disease admitted to Suizhou Central hospital from March 2014 to March 2019 were selected and divided into the observation group and control group according to random number table method,35 cases in each group.Both groups were given basic treatment;the control group was given initial treatment of human immunoglobulin on the basis of basic treatment,and the observation group was given the initial treatment of methylprednisolone(changed to prednisone acetate tablets after 3 d)combined with ulinastatin on the basis of basic treatment.Results The fever regression time in observation group was significantly shorter than that in control group(P<0.05).After 8 weeks of treatment,the coronary artery Z value showed a downward trend in the two groups,and the Z value after 8 weeks of treatment was significantly lower than that before treatment and at 1 week after treatment(P<0.05).Compared with before treatment,the white blood cell count(WBC),erythrocyte sedimentation rate(ESR),C-reactive protein(CRP)levels of the two groups were significantly reduced,and the platelet count(PLT)level was significantly increased.At 3 weeks after treatment,the above indicators were significantly better than at 1 week;the WBC of the observation group was significantly higher than that of the control group at 1,3 weeks after treatment,and the ESR was significantly lower than that of the control group(P<0.05).The drug cost and total hospitalization cost in the observation group were significantly lower than those in control group(P<0.05).There was no significant difference in the total incidence rate of drug-related adverse reactions between the two groups(17.14%vs.20.00%,χ^2=0.995,P=0.759>0.05).Conclusion Glucocorticoids combined with ulinastatin for children patients with Kawasaki disease complicated with coronary artery injury can shorten the fever course,inhibit the coronary artery expansion,facilitate the decline of ESR,and reduce the drug cost and total hospitalization cost.