探讨不同剂量IVIG联合阿司匹林对川崎病患儿临床疗效、免疫功能及血清细胞因子水平的影响  

The effects of different doses of IVIG combined with aspirin on clinical efficacy,immune function and serum cytokine levels in children with Kawasaki disease

作　　者：李晶晶[1] 邹国涛[2] 王英娟[3] 张伟[2] LI Jing-jing;ZOU Guo-tao;WANG Ying-juan;ZHANG Wei(Clinical Teaching and Research Section,Yangzhou Polytechnic Lytechnic College,225009,China;Department of Pediatrics,Yongchuan Hospital Affiliated to Chongqing Medical University,Chongqing400016,China;Department of Emergency,Yong-chuan Hospital Affiliated to Chongqing Medical University,Chongqing400016,China)

机构地区：[1]扬州市职业大学医学院临床教研室,扬州225009 [2]重庆医科大学附属永川医院儿科,重庆400016 [3]重庆医科大学附属永川医院急诊科,重庆400016

出　　处：《现代免疫学》2021年第2期134-138,共5页Current Immunology

基　　金：江苏省高等学校自然科学研究面上项目(18KJD360003)。

摘　　要：为探讨不同剂量静脉注射免疫球蛋白(intravenous immunoglobulin, IVIG)联合阿司匹林对川崎病(Kawasaki disease, KD)患儿临床疗效、免疫功能及血清细胞因子水平的影响,收集扬州大学附属医院114例KD患儿为研究对象,随机分为A、B、C 3组,每组38例。A组患儿给予口服阿司匹林治疗,B组给予常规剂量IVIG联合阿司匹林治疗,C组给予大剂量IVIG联合阿司匹林治疗。用药结束后,观察记录并比较3组患儿的临床疗效、免疫功能及血清细胞因子变化。结果显示,C组患儿四肢症状改善时间、球结膜充血、口腔黏膜充血、皮疹、发热及颈部肿大淋巴结消退时间均显著短于A组和B组(P<0.05);3组降钙素原(procalcitonin, PCT)、CRP、TNF-α及IL-6水平均较治疗前显著下降,且大剂量组显著低于单独口服阿司匹林组和常规剂量组(均P<0.05);3组的CD4^(+)T、B细胞百分比及CD4^(+)/CD8^(+)T比值均较治疗前显著降低,CD8^(+)T及NK细胞百分比显著高于治疗前(均P<0.05),且大剂量组的CD4^(+)T、B细胞百分比及CD4^(+)/CD8^(+)T均显著低于前2组,同时CD8^(+)T和NK细胞百分比显著高于前2组(均P<0.05);3组患儿冠状动脉病变及不良反应发生情况差异不显著,治疗总有效率78.07%。由此,与单独阿司匹林治疗和常规剂量IVIG联合阿司匹林治疗相比,大剂量IVIG联合阿司匹林在小儿KD的治疗中能更好提高临床疗效,降低血清细胞因子水平,同时提高患儿的免疫功能,且安全性更高。In order to explore the effects of different doses of intravenous immunoglobulin(IVIG) combined with aspirin on the clinical efficacy, immune function and serum cytokine levels of children with Kawasaki disease(KD), 114 children with KD admitted to Affiliated Hospital of Yangzhou University were enrolled and randomly divided into 3 groups: A, B and C(38 cases in each group). Children in group A were treated with oral aspirin, group B received conventional IVIG combined with aspirin treatment, and group C received high-dose IVIG and oral aspirin. After the treatment, the clinical efficacy, immune function and serum cytokine changes from the 3 groups were collected, recorded and compared. The results showed that the time to gain the improvement on limb symptoms, conjunctival hyperemia, oral mucosal hyperemia, skin rash, fever and cervical lymphadenopathy in group C was significantly shorter than that in group A and B(P<0.05);The levels of procalcitonin(PCT), CRP, TNF-α and IL-6 of all three groups were significantly lower after treatment, with the group C significantly lower than those of the group A and B(all P<0.05);Compared with pretreatment, the percentages of CD4^(+)T cells, B cells and CD4^(+)/CD8^(+)T ratio were significantly decreased in all 3 groups, whereas those of CD8^(+)T cells and NK cells were significantly increased(all P<0.05);Moreover, the percentages of CD4^(+)T, B cells and CD4^(+)/CD8^(+)T ratio in group C were significantly lower than the other two groups, while the percentages of CD8^(+)T and NK cells were significantly higher than the other two groups(all P<0.05);There was no significant difference in coronary artery disease and adverse reactions among the 3 groups and the whole effective rate was 78.07%. Therefore, compared with aspirin therapy alone and conventional doses of IVIG combined with aspirin, high-dose IVIG combined with aspirin is more effective in improving the clinical efficiency, immune funcion and reducing serum cytokine levels with high safety in the treatment of children

关 键 词：川崎病 阿司匹林 静脉注射免疫球蛋白 剂量 

分 类 号：R246.4[医药卫生—针灸推拿学]