丙种球蛋白联合阿司匹林治疗完全与不完全川崎病的疗效及作用机制研究  

Curative effect and mechanism of gamma globulin combined with aspirin for complete and incomplete Kawasaki disease

作　　者：张孝兴[1] 李倩[2] 周巍玲 ZHANG Xiaoxing;LI Qian;ZHOU Weiling(Department of Pediatric Severe Diseases,Baoji Municipal Maternity and Child Health Hospital,Shaanxi Baoji 721000 China;Department of Pediatric E.N.T.,Baoji Municipal Maternity and Child Health Hospital,Shaanxi Baoji 721000 China)

机构地区：[1]宝鸡市妇幼保健院儿童重症科,陕西宝鸡721000 [2]宝鸡市妇幼保健院儿童五官科,陕西宝鸡721000

出　　处：《中国妇幼健康研究》2021年第11期1654-1658,共5页Chinese Journal of Woman and Child Health Research

摘　　要：目的探讨丙种球蛋白联合阿司匹林治疗完全川崎病(CKD)与不完全川崎病(IKD)的疗效,并分析其作用机制。方法选择2016年1月至2019年12月于宝鸡市妇幼保健院诊治的68例川崎病儿童为研究对象,根据川崎病类型将患儿分为CKD组40例和IKD组28例,两组均采用1g/kg丙种球蛋白联合阿司匹林治疗,对比其治疗效果、临床症状改善情况、外周血T淋巴细胞[CD4+CD25+调节性T淋巴细胞(Treg)和辅助性T淋巴细胞17(Th17)比例]、血清炎症因子[肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、C反应蛋白(CRP)]、冠状动脉病变情况。结果CKD组治疗总有效率高于IKD组(χ^(2)=4.128,P<0.05),CKD组退热时间、颈淋巴结消散时间、黏膜充血时间、手足肿胀时间均短于IKD组(t值分别为4.876、3.965、3.870、4.715,P<0.05);两组治疗后Treg、Th17细胞比例均较治疗前显著下降(t值分别为17.674、16.915、26.149、24.613,P<0.05),且CKD组Treg、Th17细胞比例治疗前后差值均大于IKD组(t值分别为3.674、2.655,P<0.05);两组治疗后血清TNF-α、IL-6、CRP水平均较治疗前显著下降(t值分别为6.127、16.526、20.106、7.769、22.951、28.146,P<0.05),且CKD组血清TNF-α、IL-6、CRP水平治疗前后差值均大于IKD组(t值分别为3.050、2.292、2.131,P<0.05);治疗期间,CKD组冠状动脉病变发生率低于IKD组(χ^(2)=4.128,P<0.05)。结论1g/kg丙种球蛋白联合阿司匹林治疗CKD的效果相对IKD较好,对于IKD患者可考虑增大丙种球蛋白用药剂量和延长治疗时间。Objective To observe curative effect of gamma globulin combined with aspirin for complete Kawasaki disease(CKD)and incomplete Kawasaki disease(IKD)and to explore its mechanisms.Methods 68 children with Kawasaki disease(KD)diagnozed and treated in Baoji Municipal Maternity and Child Health Hospital over a period from January 2016 to December 2019 were selected as study subjects.According to clinical manifestation of the children with KD,they were divided into CKD group(40 cases)and IKD group(28 cases).The children in the two groups were treated with 1 g/kg of gamma globulin combined with aspirin.The therapeutic effect,improvement in clinical symptoms,peripheral blood T lymphocytes[proportions of CD4+CD25+regulatory T lymphocyte(Treg)and helper T lymphocyte 17(Th17)],serum inflammatory factors[tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),C-reactive protein(CRP)]and coronary artery lesions of the children were compared between the two groups.Results The total treatment response rate(sum of effectant rate and effective rate)in CKD group was higher than that in IKD group(χ^(2)=4.128,P<0.05).The fever abatement time,cervical lymph node dissipation time,mucosal congestion time,and hand and foot swelling time of the children in CKD group were all shorter than those in IKD group(t=4.876,3.965,3.870 and 4.715 respectively,all P<0.05).After treatment,the proportions of Treg and Th17 cells of the children in the two groups were significantly lower than those before treatment(t=17.674,16.915,26.149 and 24.613 respectively,all P<0.05),and the differences in the proportions of Treg and Th17 cells before and after treatment in CKD group were larger than those in IKD group(t=3.674 and 2.655 respectively,both P<0.05).After treatment,serum TNF-α,IL-6 and CRP levels of the children in the two groups were significantly lower than those before treatment(t=6.127,16.526,20.106,7.769,22.951 and 28.146 respectively,all P<0.05).The differences in serum TNF-α,IL-6 and CRP levels of the children in CKD group before and after treat

关 键 词：丙种球蛋白 阿司匹林 完全川崎病 不完全川崎病 疗效 

分 类 号：R725.5[医药卫生—儿科]