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目的探讨大剂量静脉丙种球蛋白治疗皮肤黏膜淋巴结综合征(川崎病)的疗效及与冠状动脉病变的关系。方法选取2006年1月-2008年12月期间住院的川崎病患儿56例。随机分为两组:治疗组采用一次大剂量(2 g/kg)静脉输注丙种球蛋白,对照组给予小剂量丙种球蛋白[400 mg/(kg.d)],1次/d,连用5 d。两组同时口服阿司匹林,急性期30～50 mg/(kg.d),热退后改为3～5 mg/(kg.d)。服用至血沉、血小板正常、无冠状病变后停药。结果治疗组24 h内体温下降者24例,72 h内退热者5例,>72 h者1例。对照组24 h内体温下降者3例,72 h内退热者15例,>72h者8例,其中3例于退热后再次发热。两组疗效比较差异有统计学意义(P<0.05)。两组患儿治疗后1周血白细胞均有下降,1个月后血小板、心电图大部分正常;治疗组出院后1个月时复查有2例发现冠状动脉损害,其中1例于3个月时消失,1例于6个月时消失。对照组出院后1个月时有4例发现冠状动脉损害,其中2例于12个月时消失,2例于24个月时消失。结论早期大剂量单次静脉输注丙种球蛋白对缓解川崎病的急性期症状及预防或减少冠状动脉损害起重要作用。而且未发现明显不良反应。
Objective To investigate the efficacy of high-dose intravenous gamma globulin in treatment of mucocutaneous lymph node syndrome (Kawasaki disease) and its relationship with coronary artery disease. Methods Fifty-six children with Kawasaki disease admitted to hospital from January 2006 to December 2008 were selected. The patients in the treatment group were given intravenous gamma globulin once a high dose (2 g / kg) and the control group were given low dose gamma globulin (400 mg / (kg.d)) once a day 5 d. Both groups took oral aspirin at the same time. The acute phase was 30-50 mg / (kg.d), and the dose was changed back to 3-5 mg / (kg.d) after thermal regress. Take to ESR, platelets normal, no coronary disease after withdrawal. Results In the treatment group, 24 cases of decreased body temperature within 24 hours, 5 cases of fever in 72 hours, and 1 case> 72 hours. In control group, the decrease of body temperature within 24 hours was found in 3 cases, 15 cases of fever in 72 hours and 8 cases of> 72 hours, of which 3 cases were fever again after fever. The difference between the two groups was statistically significant (P <0.05). One week after treatment, the number of white blood cells in the two groups dropped after 1 month. Most of the platelets and electrocardiogram were normal after one month. In the treatment group, 2 cases were found to have coronary lesions at 1 month after discharge, of which 1 case was diagnosed at 3 months Disappeared, one case disappeared at 6 months. In the control group, coronary artery lesions were found in 4 cases 1 month after discharge, of which 2 disappeared at 12 months and 2 disappeared at 24 months. Conclusion The early high-dose single intravenous infusion of gamma globulin may play an important role in alleviating the acute phase of Kawasaki disease and preventing or reducing the damage of coronary artery. And found no obvious adverse reactions.