CAJ | 학술논문

目的：探讨给予3种不同方案治疗川崎病（KD）的临床效果。方法采用非随机临床对照研究的方法，选择2011年1月－2013年12月新疆乌鲁木齐儿童医院收住院诊断为 KD 的118例患儿，根据入院时病情在给予阿司匹林的基础治疗上，分别给予3种治疗方案，根据患者家属选择治疗方案的不同分为 A、B、C 组。A 组（64例）给予静脉人血丙种球蛋白（IVIG）2．0 g/kg 标准治疗；B 组（45例）给予静脉注射甲基强的松龙（IVMP）＋乌司他丁治疗；C 组（9例）给予 IVIG 2 g/kg＋乌司他丁治疗。比较3组患者在初次治疗24、48 h 体温正常的例数、二次再治疗的比例以及治疗后1 w、3个月、6个月冠状动脉内径的变化。结果3组患儿治疗24 h 退热的比例以 B组最高（93．33％），C 组次之（77．77％），A 组最低（70．31％）；治疗48 h 后 B、C 组患儿体温降至正常，A 组有12例（18．75％）仍发热，为耐药 KD；3组患儿退热效果以 B 组最好，差异具有统计学意义（P ＜0．05）。A 组与 B 组患儿在治疗前、治疗后1 w、3及6个月冠状动脉内径差异无统计学意义（P ＞0．05）。二次再治疗的比例以 A 组最高（12例，18．75％），B 组次之（2例，4．44％），C 组无二次再治疗病例。结论甲基强的松龙＋乌司他丁治疗方案与IVIG 治疗方案相比在川崎病急性期能更好地控制体温，缩短发热时间，减轻炎症反应，治疗后未增加发生冠状动脉损害的风险；IVIG＋乌斯他定治疗方案对冠状动脉瘤的恢复有一定的促进作用。
목적：탐토급여3충불동방안치료천기병（KD）적림상효과。방법채용비수궤림상대조연구적방법，선택2011년1월－2013년12월신강오로목제인동의원수주원진단위 KD 적118례환인，근거입원시병정재급여아사필림적기출치료상，분별급여3충치료방안，근거환자가속선택치료방안적불동분위 A、B、C 조。A 조（64례）급여정맥인혈병충구단백（IVIG）2．0 g/kg 표준치료；B 조（45례）급여정맥주사갑기강적송룡（IVMP）＋오사타정치료；C 조（9례）급여 IVIG 2 g/kg＋오사타정치료。비교3조환자재초차치료24、48 h 체온정상적례수、이차재치료적비례이급치료후1 w、3개월、6개월관상동맥내경적변화。결과3조환인치료24 h 퇴열적비례이 B조최고（93．33％），C 조차지（77．77％），A 조최저（70．31％）；치료48 h 후 B、C 조환인체온강지정상，A 조유12례（18．75％）잉발열，위내약 KD；3조환인퇴열효과이 B 조최호，차이구유통계학의의（P ＜0．05）。A 조여 B 조환인재치료전、치료후1 w、3급6개월관상동맥내경차이무통계학의의（P ＞0．05）。이차재치료적비례이 A 조최고（12례，18．75％），B 조차지（2례，4．44％），C 조무이차재치료병례。결론갑기강적송룡＋오사타정치료방안여IVIG 치료방안상비재천기병급성기능경호지공제체온，축단발열시간，감경염증반응，치료후미증가발생관상동맥손해적풍험；IVIG＋오사타정치료방안대관상동맥류적회복유일정적촉진작용。
Objective To investigate the clinical efficacy of three different therapeutic schemes for Kawasaki disease (KD).Methods A non-randomized study method was adopted to treat 118 children with KD during 2011.1.1-2013.12.31.With oral aspirin as the basic treatment for KD,these patients were divided into three groups:64 patients in group A were treated with intravenos immunoglobulin(IVIG)2 g/kg as the standard treatment;45 patients in group B treated with intravenous methylprednisolone (IVMP)com-bined with intravenous ulinastatin;9 patients in group C with intravenous immunoglobulin (IVIG)2 g/kg combined with intravenous ulinastatin.The data of patients with normal temperatures in 3 groups in 24 or 48 hours after the initial treatment and the ratio of second course of treatment were collected and compared with the diameter of the coronary artery in 1 week,3 months and 6 months after the treatment.Results Group B ranked highest (93.33%)in the defervescence ratio in 3 groups in 24 hours after the treatment, with Group C the second (77.77%)and Group A the lowest one (70.31%).All patients in Group B and C had no fever in 48 hours after the treatment,12 patients in group A (18.75%)were considered to be drug-resistant KD,for their temperatures didn′t return to normal in 48 hours after the treatment.Group B had the best antipyretic effect with statistical difference (P <0.05)among the three groups.There is no statis-tical difference between Group A and Group B on the diameter of the coronary artery before the treatment and in 1 week,3 months,and 6 months after the treatment (P >0.05).12 patients in group A (18.75%) and 2 patients in group B (4.44%)received second course of treatment while no patients in group C re-ceived second course of treatment.Conclusion Compared with standard IVIG treatment,Methylpred-nisolone and ulinastatin treatment for Kawasaki disease in the acute phase can better control the tempera-ture,shorten the fever duration and reduce inflammation,with no risk of coronary artery aneurysm.IVIG treatment combined with ulinastatin had better effects than the individual IVIG treatment.