川崎病的一线辅助治疗进展

Advances in First-line Adjuvant Therapy for Kawasaki Disease

川崎病好发于5岁以下儿童,其最大的危害是冠状动脉损害。目前其发病机制尚不明确,炎症反应可能是其发病的主要原因。大剂量静脉注射丙种球蛋白联合阿司匹林是公认的一线治疗方案,但仍有部分川崎病患儿治疗失败,并且这些患儿冠状动脉扩张和冠状动脉瘤的风险更高。因此,有多种辅助治疗(糖皮质激素、肿瘤坏死因子-α拮抗剂、免疫抑制剂、大环内酯类药物和蛋白酶抑制剂等)也被用于川崎病的一线治疗。目前川崎病一线辅助治疗首选糖皮质激素,但仍需进一步研究以期为临床治疗提供指导。

Kawasaki disease often occurs in children under 5 years of age.Its greatest harm is to cause coronary artery damage.The pathogenesis of Kawasaki disease is not yet clear,and inflammation may be the main cause.The recognized first-line treatment is high-dose intravenous immunoglobulin combined with aspirin,which still fails in some children with higher risk for coronary artery dilatation and aneurysm.Therefore,a variety of adjuvant therapies,such as glucocorticoids,tumor necrosis factor-αantagonist,immunosuppressants,macrolides and protease inhibitors,are also used in the first-line treatment of Kawasaki disease.At present,glucocorticoid is the first choice for the first-line adjuvant treatment of Kawasaki disease,but further research is still needed to provide guidance for the clinical treatment.