甲基泼尼松龙治疗IVIG无反应型川崎病的效果评价

Effect evaluation of methylprednisolone in treatment of IVIG unresponsive Kawasaki disease

目的观察甲基泼尼松龙治疗静脉注射丙种球蛋白(IVIG)无反应型川崎病(KD)的临床疗效及对实验室相关指标的影响。方法选择在本院治疗的IVIG无反应型KD患儿60例,将其按随机数字表法分为两组,各30例。对照组接受IVIG再次冲击治疗;于对照组基础上,观察组加甲基泼尼松龙治疗。观察两组临床疗效、实验室相关指标[肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)]、冠脉损伤发生率及不良反应。结果观察组有效率为90.00%,高于对照组的66.67%,(χ^(2)=4.812,P<0.05);治疗前两组TNF-α、IL-6水平及冠脉损伤率对比差异无统计学意义(t=0.049、0.032,χ^(2)=0.067,P值均>0.05);治疗后观察组TNF-α为(9.80±3.73)ng/L、IL-6为(19.72±6.29)ng/L,均低于对照组的(13.97±4.21)ng/L、(32.85±7.48)ng/L,(t=5.397、9.781,P值均<0.05)、治疗后观察组冠脉损伤率为3.33%,低于对照组的23.33%,(χ^(2)=3.606,P<0.05)。观察组、对照组不良反应发生率分别为10.00%、6.67%,差异无统计学意义(χ^(2)=0.000,P值>0.05)。结论IVIG无反应型KD患儿接受甲基泼尼松龙治疗有利于提升治疗效果且安全,利于减少冠脉损伤,改善炎症反应。

Objective To observe the clinical efficacy of methylprednisolone in the treatment of intravenous immunoglobulin(IVIG)(gamma globulin) unresponsive Kawasaki disease(KD) and its influence on laboratory related indexes.Methods A total of 60 children with IVIG unresponsive KD were randomly divided into a control group and an observation group with 30 cases in each group.The control group was treated with IVIG again;on the basis of the control group,the observation group was treated with methylprednisolone.The clinical efficacy,laboratory related indexes [tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)],incidence of coronary artery injury and adverse reactions were observed.Results The effective rate of the observation group(90.00%) was higher than that of the control group(66.67%)(χ2=4.812,P <0.05);before the treatment,there was no significant difference in the levels of TNF-α,IL-6 and coronary artery injury rate between the two groups(t=0.049,0.032,χ2=0.067,P> 0.05);after the treatment,the levels of TNF-α and IL-6 in the observation group were(9.80±3.73) ng/L and(19.72±6.29) ng/L,respectively,and the coronary artery injury rate was 3.33%,which were lower than those in the control group [(13.97±4.21) ng/L,(32.85±7.48) ng/L(t=5.397,9.781,P <0.05),23.33%(χ2=3.606,P <0.05)].The incidence of adverse reactions in the observation group and the control group were 10.00% and6.67% respectively,and the difference was not statistically significant(χ2=0.000,P> 0.05).Conclusion Methylprednisolone treatment in the children with IVIG nonresponsive KD can improve the therapeutic effect and safety,reduce coronary artery injury and improve inflammatory re sponse.