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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)2.0g/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 2g/kg+乌司他丁治疗。比较3组患者在初次治疗24、48h体温正常的例数、二次再治疗的比例以及治疗后1w、3个月、6个月冠状动脉内径的变化。结果 3组患儿治疗24h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48h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1w、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。
Objective To investigate the clinical effects of Kawasaki disease (KD) treated with three different regimens. Methods A total of 118 children diagnosed as KD admitted to Urumqi Children’s Hospital from January 2011 to December 2013 were selected according to a non-randomized controlled clinical trial. According to the condition of the hospital admission to aspirin, Treatment options, according to the choice of family members of patients with different treatment programs are divided into A, B, C group. Group A (64 cases) received IVIG 2.0g / kg standard treatment; Group B (45 cases) received intravenous methylprednisolone (IVMP) + ulinastatin treatment; Group C (9 cases) given IVIG 2g / kg + ulinastatin treatment. The number of patients with normal body temperature at 24,48 hours after primary treatment, the proportion of secondary re-treatment, and the change of coronary artery diameter at 1, 3, and 6 months after treatment were compared between the three groups. Results After treatment for 24 hours, the rate of fever in group B was the highest (93.33%) in group B, followed by group C (77.77%) and lowest in group A (70.31%). After 48 hours of treatment, the body temperature of children in groups B and C dropped to normal . In group A, 12 cases (18.75%) were still fever and were resistant to KD. The antipyretic effect in group B was the best, with significant difference (P <0.05). There was no significant difference in coronary diameter at 1, 3 and 6 months after treatment in children in group A and group B before treatment (P> 0.05). The rate of secondary re-treatment was highest in group A (12 cases, 18.75%), group B (2 cases, 4.44%), and group C did not have any second re-treatment. Conclusions Methylprednisolone + ulinastatin regimen is better able to control body temperature, shorten the time of fever and reduce the inflammatory reaction in acute stage of Kawasaki disease than IVIG treatment without increasing the risk of coronary artery lesion after treatment ; IVIG + Ustattin treatment of coronary artery aneurysm recovery has a certain role in promoting.