川崎病并发冠状动脉瘤抗凝治疗的临床疗效及对远期转归的影响

Clinical efficacy of anticoagulant therapy for Kawasaki disease complicated with coronary artery aneurysm and its influence on the long-term outcome

目的探讨川崎病并发冠状动脉瘤抗凝治疗的临床疗效及对远期转归的影响。方法收集2016年1月至2019年7月济宁医学院附属医院收治的78例川崎病并发冠状动脉瘤患儿的临床资料,根据治疗方式的不同将患儿分为常规组(采用常规抗凝治疗)和观察组(在常规治疗的基础上应用双嘧达莫治疗),每组39例。比较两组患儿的临床疗效,以及治疗前后的炎性反应指标[血清C反应蛋白(CRP)、血清肿瘤坏死因子-α(TNF-α)水平、血清白细胞介素-6(IL-6)水平、白细胞计数(WBC)、血沉(ESR)水平]和凝血功能指标[血小板计数(PLT)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(Fib)水平]。治疗后随访1年,比较两组患儿的血管内皮功能指标,包括肱动脉内皮依赖性舒张功能(FMD)、非内皮依赖性舒张功能(NMD)、颈动脉僵硬度指数(SI)和颈动脉内中膜厚度(IMT)。记录并比较两组患儿的远期不良转归情况,指标包括血栓、心肌梗死、冠状动脉狭窄、心脏增大、左心功能降低的发生率。结果观察组患儿的临床疗效优于常规组,差异有统计学意义(P=0.022)。观察组患儿的总有效率为97.44%(38/39),高于常规组患儿的76.92%(30/39),差异有统计学意义(P=0.007)。治疗后,观察组患儿的CRP、TNF-α、IL-6、WBC、ESR水平均明显低于常规组患儿,差异均有统计学意义(P<0.01)。治疗后,观察组患儿的PLT明显少于常规组患儿,PT、APTT均明显长于常规组患儿,Fib水平明显低于常规组患儿,差异均有统计学意义(P<0.01)。治疗后1年,观察组患儿的FMD、NMD均高于常规组患儿,SI、IMT均低于常规组患儿,差异均有统计学意义(P<0.05)。两组患儿的血栓、心肌梗死、冠状动脉狭窄、心脏增大、左心功能降低的发生率比较,差异均无统计学意义(P>0.05)。结论双嘧达莫联合常规抗凝治疗能够提高川崎病并发冠状动脉瘤患儿的临床疗效,减轻炎性反应和高凝状态,改善血管内皮功能和远期转归。

Objective To investigate the clinical efficacy of anticoagulant therapy for Kawasaki disease combined with coronary artery aneurysm and and its influence on the long-term outcome.Method The clinical data of 78 children with Kawasaki disease with coronary artery aneurysm treated in Affiliated Hospital of Jining Medical College from January 2016 to July 2019 were collected.According to different treatment methods,the children were divided into routine group(routine anticoagulation treatment)and observation group(dipyridamole treatment on the basis of routine treatment),with 39 cases in each group.The clinical efficacy and inflammatory reaction indicator[serum C-reactive protein(CRP),serum tumor necrosis factor-α(TNF-α),serum interleukin-6(IL-6),white blood cell(WBC),erythrocyte sedimentation rate(ESR)levels]and coagulation indexes[platelet(PLT),prothrombin time(PT),activated partial thrombin time(APTT)and fibrinogen(Fib)levels]were compared between the two groups.The patients were followed up for 1 year after treatment.The vascular endothelial function indicators of the two groups were observed,including brachial arterial flow-mediated dilation(FMD),nitroglycerin-mediated dilation(NMD),carotid artery stiffness index(SI)and carotid intima-media thickness(IMT),and the adverse outcomes of the two groups were recorded and compared,the indicators included the incidence of thrombosis,myocardial infarction,coronary artery stenosis,enlargement of the heart,and reduced left heart function.Result The clinical efficacy of the observation group was better than that of the routine group,and the difference was statistically significant(P=0.022).The total clinical effective rate of the study group was 97.44%(38/39),which was higher than 76.92%(30/39)in the routine group(P=0.007).After treatment,the levels of CRP,TNF-α,IL-6,WBC and ESR in the observation group were significantly lower than those in the routine group(P<0.01).After treatment,PLT in the observation group was significantly less than that in the routine group,PT and APTT were significantly longer than those in the routine group,and Fib level was significantly lower than that in the routine group(P<0.01).One year after treatment,FMD and NMD in the observation group were higher than those in the routine group,and SI and IMT were lower than those in the routine group(P<0.05).There was no significant difference in the incidence of thrombosis,myocardial infarction,coronary artery stenosis,cardiac enlargement and decreased left ventricular function between the two groups(P>0.05).Conclusion Dipyridamole combined with routine anticoagulation therapy can improve the clinical efficacy of children with Kawasaki disease complicated with coronary aneurysm,further reduce the inflammatory response and hypercoagulability,and improve the prognosis of vascular endothelial function and long-term outcome in children.