免疫球蛋白联合阿司匹林治疗儿童川崎病的价值探析

The value of immunoglobulin combined with aspirin in the treatment of Kawasaki's disease in children

目的 分析免疫球蛋白联合阿司匹林治疗儿童川崎病(KD)的效果。方法 204例川崎病患儿为研究对象,均采用免疫球蛋白静脉滴注^(+)阿司匹林口服治疗。分析患儿的治疗效果、退热率、药物不良反应发生率、治疗后的C反应蛋白(CRP)正常率、治疗后的不良结局发生率,比较患儿治疗前后的免疫功能指标(CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+))水平。结果 204例患儿中,显著见效130例(63.73%),初步见效67例(32.84%),未见疗效7例(3.43%),总有效197例(96.57%)。患儿使用免疫球蛋白24 h后退热191例,退热率为93.63%(191/204)。患儿发生4例(1.96%)静脉炎, 5例(2.45%)面色潮红, 1例(0.49%)过敏反应,药物不良反应发生率为4.90%(10/204)。治疗1、2周后,患儿的CRP正常率分别为82.35%(168/204)、100.00%(204/204)。患儿治疗前的CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平分别为(42.36±4.91)%、(24.98±1.77)%、(0.81±0.15),治疗1周后的CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平分别为(45.43±4.73)%、(27.13±1.65)%、(0.95±0.18),治疗2周后的CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平分别为(49.39±4.69)%、(30.28±1.67)%、(1.14±0.16)。患儿治疗1、2周后的CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)均高于治疗前,治疗2周后的CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)均高于治疗1周后,差异具有统计学意义(P<0.05)。204例患儿治疗后出现4例(1.96%)冠状动脉损害。结论 川崎病患儿采用免疫球蛋白静脉滴注^(+)阿司匹林口服治疗可减轻发热症状,抑制炎症反应,优化免疫功能,且用药安全性比较高。

Objective To analyze the effect of immunoglobulin combined with aspirin in the treatment of Kawasaki's disease(KD)in children.Methods 204 children with Kawasaki's disease were studied and treated with intravenous immunoglobulin and oral aspirin.The therapeutic effect,antipyretic rate,incidence of adverse drug reactions,percentage of normal C-reactive protein(CRP)rate after treatment,incidence of adverse outcomes after treatment were analyzed,and the levels of immune function indicators(CD3^(+),CD4^(+),CD4^(+)/CD8^(+))before and after treatment were compared.Results Among the 204 children,130 cases(63.73%)showed significant effect,67 cases(32.84%)showed preliminary effect,7 cases(3.43%)showed no effect,and the total number of effective cases was 197(96.57%).The fever of the children subsided in 191 cases after 24 h of immunoglobulin use,and theantipyretic rate was 93.63%(191/204).There were 4 cases(1.96%)of phlebitis,5 cases(2.45%)of flushing face and 1 case(0.49%)of anaphylaxis,with an incidence of adverse drug reactions of 4.90%(10/204).After 1 and 2 weeks of treatment,the percentage of normal CRP were 82.35%(168/204)and 100.00%(204/204),respectively.Before treatment,the levels of CD3^(+),CD4^(+),CD4^(+)/CD8^(+)were(42.36±4.91)%,(24.98±1.77)%,(0.81±0.15),respectively;after 1 week of treatment,the levels of CD3^(+),CD4^(+),CD4^(+)/CD8^(+)were(45.43±4.73)%,(27.13±1.65)%,(0.95±0.18),respectively;after 2 weeks of treatment,the levels of CD3^(+),CD4^(+),CD4^(+)/CD8^(+)were(49.39±4.69)%,(30.28±1.67)%,(1.14±0.16),respectively.After 1 and 2 weeks of treatment,CD3^(+),CD4^(+),CD4^(+)/CD8^(+)were higher than those before treatment;after 2 weeks of treatment,the levels of CD3^(+),^(+)CD4 and CD4^(+)/CD8^(+)were higher than those after 1 week of treatment;the differences were statistically significant(P<0.05).Coronary artery damage occurred in 4(1.96%)of 204 children after treatment.Conclusion Intravenous immunoglobulin^(+)oral aspirin therapy in children with Kawasaki's disease can reduce fever symptoms,inhibit inflammatory response,optimize immune function,and has high drug safety.