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目的观察甲基泼尼松龙(IVMP)联合静脉丙种球蛋白(IVIG)治疗IVIG无反应型川崎病(KD)患儿的临床效果。方法将42例IVIG无反应型KD患儿随机分为观察组和对照组,每组21例,对照组继续予以IVIG 2.0g/kg静脉滴注;观察组在对照组基础上予以IVMP 2 mg·kg-1·d-1治疗,使用3 d。比较2组治疗前后临床症状、实验室检查(WBC、ESR、hs-CRP)及不良反应;随访1年,比较2组发生冠状动脉扩张(CAL)情况。结果治疗后,观察组临床症状和体征消退时间均明显短于对照组(P<0.01)。2组WBC、ESR和hs CR在治疗36 h、72 h监测值与入院时比较,差异均有统计学意义(P<0.01);治疗后72 h,2组WBC、ESR和hs-CRP数值比较差异显著有统计学意义(P<0.01)。随访1年,观察组CAL发生率低于对照组(P<0.05)。结论小剂量IVMP联合静脉滴注IVIG治疗IVIG无反应型KD患儿可有效控制炎性反应、发热等临床症状,缩短病程及减少冠状动脉病变的发生。
Objective To observe the clinical efficacy of methylprednisolone (IVMP) combined with intravenous gamma globulin (IVIG) in the treatment of children with IVIG non-responsive Kawasaki disease (KD). Methods Twenty-four children with IVG nonresponsive KD were randomly divided into observation group and control group, with 21 cases in each group. IVIG 2.0g / kg intravenous drip was continued in the control group. IVMP 2 mg · kg-1 · d-1 for 3 days. The clinical symptoms, laboratory tests (WBC, ESR, hs-CRP) and adverse reactions were compared between the two groups before and after treatment. The coronary artery dilatation (CAL) was compared between the two groups after one year follow-up. Results After treatment, clinical symptoms and signs subsided in the observation group were significantly shorter than those in the control group (P <0.01). The differences of WBC, ESR and hs-CRP between the two groups were statistically significant at 36 h and 72 h after treatment (P <0.01), and at 72 h after treatment The difference was statistically significant (P <0.01). One year follow-up, the incidence of CAL in observation group was lower than that in control group (P <0.05). Conclusion IV IV IVIG combined with intravenous drip IVIG can effectively control the clinical symptoms such as inflammatory reaction and fever, shorten the course of disease and reduce the occurrence of coronary artery disease in children with IVIG non-responsive KD.