阿司匹林不同减量方案的预测指标及在川崎病患儿治疗中的应用

Predictive Index with Different Dosage Reduction Schemes of Aspirin in Kawa⁃saki Disease Children

目的研究阿司匹林不同减量方案的预测指标及对川崎病患儿的临床效果。方法纳入2020年6月至2021年6月海南省妇女儿童医学中心收治的94例川崎病患儿作为研究对象。所有患儿均进行阿司匹林+人免疫球蛋白治疗,并在72 h后复查血常规和C反应蛋白(C-reactive protein,CRP)浓度。将CRP浓度恢复正常的患儿作为A组(n=44),CRP浓度异常的患儿作为B组(n=50)。按随机数字表法将A、B两组患儿分为A1、A2组各22例和B1、B2组各25例。A1和B1组采用阿司匹林逐渐减量治疗,A2和B2组采用阿司匹林直接减量治疗。观察阿司匹林不同减量方案对A、B两组患儿血常规、天门冬氨酸氨基转移酶(aspartate aminotransferase,AST)和丙氨酸氨基转移酶(alanine aminotransferase,ALT)浓度的影响,分析A、B两组患儿冠状动脉并发症发生率以及再次使用人免疫球蛋白的概率。结果治疗前A1、A2组患儿白细胞计数(white blood cell count,WBC)、血小板计数(platelet count,PLT)、红细胞沉降率(erythrocyte sedimentation rate,ESR)、CRP、AST以及ALT浓度比较,差异无统计学意义(P>0.05);治疗后两组患儿上述指标浓度比较,差异仍无统计学意义(P>0.05)。治疗前B1、B2组患儿WBC、PLT、ESR、CRP、AST以及ALT浓度比较,差异无统计学意义(P>0.05);治疗后B1组患儿上述指标浓度均低于B2组患儿,差异有统计学意义(P<0.05)。A组患儿冠状动脉并发症发生率和再次使用人免疫球蛋白概率均低于B组,差异有统计学意义(P<0.05)。B1组患儿冠状动脉并发症发生率和再次使用人免疫球蛋白概率均低于B2组,差异有统计学意义(P<0.05)。结论川崎病患儿治疗72 h后若CRP浓度恢复正常,推荐阿司匹林直接减量方案;若治疗72 h后仍未恢复正常,则推荐使用阿司匹林逐渐减量的方案。以上阿司匹林减量策略能有效提高患儿治疗效果,降低并发症发生率,减少人免疫球蛋白的应用,值得临床应用及推广。

Objectives To study the predictive index with different dosage reduction schemes of aspirin in Kawasaki disease children.Methods Totally 94 Kawasaki disease children of taking aspirin and human immunoglobulin from June 2020 to June 2021 in Hainan Women and Children′s Medical Center were selected as research subjects.After 72 h of therapy,blood routine examination results and concentration of C-reactive protein(CRP)were recorded.Children were assigned to A group(n=44,normal CRP)and B group(n=50,abnormal CRP).A group was further classified as A1 group(n=22)and A2 group(n=22);B group was further classified as B1 group(n=25)and B2 group(n=25).A1 group and B1 group took the gradual dosage reduction of aspirin;A2 group and B2 group took the direct dosage reduction of aspirin.Blood routine examination results,concentrations of aspartate aminotransferase(AST)and alanine aminotrans⁃ferase(ALT),incidence of coronary artery complications and repeated usage rate of immune globulin were analyzed.Results Before treatment,WBC(white blood cell count),PLT(platelet conunt),ESR(erythrocyte sedimentation rate),CRP,AST and ALT between A1 group and A2 group were not significantly different(P>0.05);after treatment,the above indicators between group A1 group and A2 group were not significantly different(P>0.05).Before treatment,WBC,PLT,ESR,concentrations of CRP,AST and ALT between B1 group and B2 group were not significantly different(P>0.05);after treatment,related values in B1 group were significantly lower than those of B2 group(P<0.05).Incidence of coronary artery complications and repeated usage rate of immune globulin in A group were significantly lower than those of B group(P<0.05).Incidence of coronary artery complications and repeated usage rate of immune globulin in B1 group were significantly lower than those of B2 group(P<0.05).Conclusions The direct dosage reduction of aspirin is applied for children with normal concentration of CRP after 72 h of therapy.Meanwhile,the gradual dosage reduction of aspirin is used for children with abnormal concentration of CRP.The different dosage reduction schemes of aspirin can increase the treatment effects,and reduce the complications and dosage of immune globulin in Kawasaki disease children.It is worthy of clinical application and promotion.