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目的:探讨小剂量甲基泼尼松联合静脉丙种球蛋白(IVIG)治疗IVIG无反应型川崎病(KD)患儿的临床疗效。方法:将32例IVIG无反应型KD患儿随机分为治疗组和对照组各16例,对照组在常规治疗基础上静脉滴注IVIG 2.0 g/kg治疗1次;治疗组在对照组基础上加用甲基泼尼松2 mg/(kg·d)治疗3 d。比较两组患儿治疗前后的临床症状、白细胞(WBC)计数、血沉(ESR)和超敏C反应蛋白(hs CRP)水平;比较两组患儿治疗后血小板(PLT)计数、D-二聚体(D-dimer)水平、纤维蛋白原(FIB)水平和不良反应;随访1年,比较两组发生冠状动脉扩张(CAL)情况。结果:治疗后,治疗组临床症状恢复时间均短于对照组(P<0.05);两组在入院时和初次治疗后36 h WBC计数、ESR和hs CRP水平比较差异均无统计学意义(P>0.05);治疗后72 h治疗组WBC计数、ESR和hs CRP水平均低于对照组(P<0.05);两组治疗后PLT、D-dimer水平和FIB水平比较差异无统计学意义(P>0.05);随访1年,治疗组发生CAL例数低于对照组(P<0.05)。结论:小剂量甲基泼尼松联合静脉滴注IVIG治疗IVIG无反应型KD患儿可以明显改善患儿临床症状,迅速改善急性期炎性反应指标,快速控制血管炎症,有效减少冠状动脉病变的发生。
Objective: To investigate the clinical efficacy of low-dose methylprednisone combined with intravenous gamma globulin (IVIG) in the treatment of children with IVIG non-responsive Kawasaki disease (KD). Methods: Thirty-two cases of IVIG nonresponsive KD children were randomly divided into treatment group and control group, 16 cases in each group. The control group was treated with intravenous infusion of IVIG 2.0 g / kg on the basis of routine treatment. On the basis of the control group Plus methylprednisone 2 mg / (kg · d) for 3 d. The clinical symptoms, WBC count, erythrocyte sedimentation rate (ESR) and hsCRP level were compared between the two groups before and after treatment. The PLT count, D-dimer (D-dimer) level, fibrinogen (FIB) level and adverse reactions; follow-up of 1 year, comparing the two groups of occurrence of coronary artery dilatation (CAL). Results: After treatment, the recovery time of clinical symptoms in the treatment group was shorter than that in the control group (P <0.05). There were no significant differences in WBC count, ESR and hs CRP levels between the two groups at 36 h after admission and at the first treatment (P > 0.05) .WBC counts, ESR and hs CRP levels in the treatment group at 72 h after treatment were lower than those in the control group (P <0.05). There was no significant difference in the levels of PLT, D-dimer and FIB > 0.05). After one year follow-up, the number of CAL cases in the treatment group was lower than that in the control group (P <0.05). CONCLUSIONS: Small doses of methylprednisone combined with IVIG for IVIG non-responsive KD can significantly improve children’s clinical symptoms, rapidly improve inflammatory response in acute phase, rapidly control vascular inflammation and effectively reduce coronary artery lesions occur.