氯吡格雷联合阿司匹林在川崎病合并中小型冠状动脉瘤患儿治疗中的临床效果

Clinical Effect of Clopidogrel Combined with Aspirin in Kawasaki Disease Patients with Small and Medium-sized Coronary Aneurysms

目的分析将氯吡格雷联合阿司匹林方案应用于川崎病合并中小型冠状动脉瘤患儿治疗中的临床效果。方法随机选取2020年2月—2022年6月福建医科大学附属漳州市医院儿童心肺消化科收治的170例川崎病合并中小型冠状动脉瘤患儿为研究对象,采用随机数表法分成对照组及观察组,各85例。对照组采用低分子肝素联合阿司匹林治疗,观察组采用氯吡格雷联合阿司匹林治疗,比较两组血液检验结果、冠状动脉瘤治疗效果、心血管事件和并发症发生情况。结果治疗后,两组血小板计数、白细胞介素-3、白细胞介素-6、基质金属蛋白酶-9水平均优于治疗前,且观察组血小板计数、白细胞介素-3、白细胞介素-6均低于对照组,差异有统计学意义(P均<0.05)。随访3个月,观察组冠状动脉恢复正常率为25.88%,冠状动脉回缩率为32.94%,冠状动脉稳定率为38.82%,冠状动脉发展率为2.35%,与对照组的12.94%、30.59%、49.41%、7.06%比较,差异无统计学意义(P均>0.05)。观察组冠状动脉瘤治疗总有效率为58.82%,高于对照组的43.53%,差异有统计学意义(P<0.05)。治疗期间,观察组发生冠状动脉血栓者1例,对照组无冠状动脉血栓发生,两组心血管不良事件发生率对比,差异无统计学意义(P>0.05)。随访3个月内,观察组并发症总发生率(20.00%)与对照组(24.71%)比较,差异无统计学意义(P>0.05)。结论采取氯吡格雷与阿司匹林联合应用方案用于川崎病合并中小型冠状动脉瘤患儿的治疗中,疗效确切,安全性较好。

Objective To analyze the clinical effects of clopidogrel combined with aspirin in the treatment of Kawasaki disease with small and medium-sized coronary aneurysms.Methods A total of 170 children with Kawasaki disease complicated with small and medium-sized coronary aneurysm admitted to the Department of Children's Cardiopulmonary Gastroenterology of Zhangzhou Hospital Affiliated to Fujian Medical University from February 2020 to June 2022 were randomly selected as the study objects and were divided into the control group and the observation group by random number table method,with 85 cases in each group.The control group was treated with low molecular weight heparin combined with aspirin,and the observation group was treated with clopidogrel combined with aspirin.Blood test results,treatment effect of coronary aneurysm,incidence rate of cardiovascular adverse events and complications were compared between the two groups.Results After treatment,platelet count,interleukin-3,interleukin-6 and matrix metalloproteinase-9 of the two groups were all better than those before treatment,and platelet count,interleukin-3,interleukin-6 in the observation group was lower than those in the control group,and the differences were statistically significant(all P<0.05).After 3 month of follow-up,the observation group's coronary artery recovery rate was 25.88%,coronary artery retraction rate was 32.94%,coronary artery stability rate was 38.82%,and coronary artery development rate was 2.35%,compared with the control group's 12.94%,30.59%,49.41%,and 7.06%,and the differences were not statistically significant(all P>0.05).The total effective rate in the observation group was 58.82%,which was higher than 43.53%in the control group,and the difference was statistically significant(P<0.05).During treatment,1 case of coronary thrombosis occurred in the observation group,while no coronary thrombosis occurred in the control group,and the difference of incidence rate of cardiovascular adverse events between the two groups was not statistically significant(P>0.05).Within 3 months of follow-up,the total incidence rate of complications in the observation group was 20.00%,compared with 24.71%in the control group,and the difference was not statistically significant(P>0.05).Conclusion The combination of clopidogrel and aspirin in the treatment of Kawasaki disease with small and medium-sized coronary aneurysms is effective and safe.