糖皮质激素对川崎病患儿急性期治疗效果的影响

Influence of glucocorticoid on therapeutic effect of children with Kawasaki disease during acute stage

目的研究糖皮质激素对川崎病患儿急性期治疗效果的影响。方法纳入2018年1月—2023年1月期间孝感市中心医院收治的92例川崎病(KD)患儿,随机分为常规组与联合组各46例,常规组实施人免疫球蛋白+阿司匹林治疗,联合组在常规组基础上联合糖皮质激素治疗,两组患者均治疗两周。比较两组KD患儿用药后临床症状消失时间[发热、黏膜充血、四肢肿胀]。比较两组KD患儿治疗前后抗血小板聚集相关因子水平[血小板计数(PLT)、白细胞计数(WBC)、红细胞沉降率(ESR)]、炎症因子[生长分化因子-15(GDF-15)、巨噬细胞移动抑制因子(MIF)、血清高迁移率族蛋白B1(HMGB1)]、免疫功能[CD4^(+)、CD8^(+)]、冠状动脉内径。比较两组KD患儿治疗期间药物不良反应发生情况。结果联合组KD患儿发热、黏膜充血、四肢肿胀等临床症状消失时间显著低于常规组(P<0.05)。治疗两周后,两组患儿PLT、WBC、ESR、GDF-15、MIF、HMGB1、CD4^(+)水平显著低于治疗前,且联合组显著低于常规组(P<0.05);两组KD患儿CD8^(+)水平显著高于治疗前,且联合组显著高于常规组(P<0.05)。治疗后两组患儿冠状动脉内径较治疗前显著减小,但两组间冠状动脉内径比较差异无统计学意义(P>0.05)。两组患儿不良反应总发生率比较差异无统计学意义(P>0.05)。结论糖皮质激素联合人免疫球蛋白治疗KD患儿可促进其临床症状消失,并有利于提高其抗血小板聚集能力,降低炎症反应。

Objective To study the Influence of glucocorticoid on therapeutic effect of children with Kawasaki disease(KD)during acute stage.Methods 92 children with KD admitted from January 2018 to January 2023 were included and randomly divided into conventional group and combined group with 46 cases in each group.The conventional group was treated with human immunoglobulin+aspirin,and the combined group was given glucocorticoid on the basis of the conventional group.Both groups of patients were treated for 2 weeks.The disappearance times of clinical symptoms(fever,mucosal congestion,limb swelling)after medication,anti-platelet aggregation-related factors[platelet count(PLT),white blood cell count(WBC),erythrocyte sedimentation rate(ESR)],inflammatory factors[growth differentiation factor-15(GDF-15),macrophage migration inhibitory factor(MIF),serum high mobility group box 1(HMGB1)]and immune function(CD4^(+),CD8^(+))and coronary artery diameter before and after treatment and occurrence of adverse drug reactions during treatment were compared between the two groups of KD children.Results The disappearance times of clinical symptoms such as fever,mucosal congestion and limb swelling in combined group were significantly shorter than those in conventional group(P<0.05).After 2 weeks of treatment,the levels of PLT,WBC,ESR,GDF-15,MIF,HMGB1 and CD4^(+)in both groups were significantly lower than those before treatment,and the levels were significantly lower in combined group than those in conventional group(P<0.05).The level of CD8^(+)in KD children in the two groups was significantly higher than that before treatment,and the level in combined group was significantly higher compared with that in conventional group(P<0.05).After treatment,the coronary artery diameter in the two groups was significantly reduced compared with that before treatment,but there was no statistically significant difference between the two groups(P>0.05).There was no statistically significant difference in the total incidence rate of adverse reactions between the two groups(P>0.05).Conclusion Glucocorticoid combined with human immunoglobulin in the treatment of children with KD can promote the clinical symptom disappearance,help to enhance the anti-platelet aggregation ability and reduce the inflammatory response.