糖皮质激素治疗静脉注射免疫球蛋白无反应型川崎病患儿的临床疗效分析  

Clinical effect of glucocorticoid on children with intravenous immunoglobulin non-responsive Kawasaki disease

作　　者：何远燕 熊若男 陈凤 He Yuan-yan;Xiong Ruo-nan;Chen Feng(Department of Pediatrics,The Affiliated Hospital of Xinyang Vocational and Technical College,Xinyang 464000,Henan,China;Department of Pediatrics,Xinyang Central Hospital,Xinyang 464000,Henan,China)

机构地区：[1]信阳职业技术学院附属医院儿科,河南信阳464000 [2]信阳市中心医院儿科,河南信阳464000

出　　处：《四川生理科学杂志》2023年第8期1363-1366,1413,共5页Sichuan Journal of Physiological Sciences

摘　　要：目的:观察糖皮质激素治疗静脉注射免疫球蛋白(Intravenous immunoglobulin,IVIG)无反应型川崎病(Kawasaki disease,KD)患儿的疗效及对患儿心率变异、炎性因子及免疫功能的影响。方法:选取2020年5月至2022年5月我院收治的60例IVIG无反应型KD患儿作为研究对象,按随机数字表法分为常规治疗组和糖皮质激素组,各30例。常规治疗组采用人免疫球蛋白和阿司匹林治疗,糖皮质激素组在常规治疗组基础上增加糖皮质激素治疗。治疗后,比较临床疗效、临床症状改善情况、24 h动态心电图心率变异性(Heart rate variability,HRV)变化、炎性因子和免疫功能。结果:治疗后,糖皮质激素组总有效率明显高于常规治疗组(P<0.05);退热、黏膜充血消退、手足肿胀消退及颈淋巴结肿大消退时间均明显短于常规治疗组(P<0.05)。治疗后,糖皮质激素组的全程正常窦性心搏RR间期标准差(Standard deviation of the R-R interval of normal sinus beats,SDNN)、每5 min节段平均心搏RR间期均值标准差(Standard deviation of the mean R-R interval for each 5 minutes,SDANN)、心搏间期差值>50 ms个数百分比(The percentage of successive NN intervals>50 ms,pNN50)、24 h每隔5 min所有窦性心搏心率间期标准差的均值(Mean of the standard deviations of all normal to normal intervals for all 5-min segments of the entire recording,SDNN index)、分化决定族抗原4^(+)(Cluster of differentiation 4^(+),CD4^(+))细胞、自然杀伤(Natural killing,NK)细胞均明显高于常规治疗组,白介素-6(Interleukin-6,IL-6)、C反应蛋白(C-reactive protein,CRP)、血管内皮生长因子(Vascular endothelial growth factor,VEGF)、肿瘤坏死因子-α(Tumor necrosis factor-α,TNF-α)、分化决定族抗原8^(+)(Cluster of differentiation 8^(+),CD8^(+))细胞均明显低于常规治疗组(P<0.05)。结论:糖皮质激素治疗IVIG无反应型KD患儿的疗效确切,可快速改善患儿各种临床症状和心率变异,降低炎性因子�Objective:To observe the efficacy of glucocorticoid on children with intravenous immunoglobulin(IVIG)non-responsive Kawasaki disease(KD),and the influence on heart rate variation,inflammatory factors and immune function.Methods:A total of 60 children with IVIG non-responsive KD in our hospital from May 2020 to May 2022 were selected as research objects and they were divided into conventional treatment group and glucocorticoid group according to random number table method,with 30 cases in each group.The conventional treatment group was treated with human immunoglobulin and aspirin,and the glucocorticoid group was additionally treated with glucocorticoid.After treatment,the clinical efficacy,the improvement of clinical symptoms,the variability of 24 h heart rate variability(HRV),inflammatory factors and immune function were compared between the two groups.Results:After treatment,the total effective rate of glucocorticoid group was significantly higher than that of conventional treatment group(P<0.05).The time of fever regression,mucosal congestion regression,hand and foot swelling regression and neck lymphatic swelling regression were significantly shorter than those of conventional treatment group(P<0.05).After treatment,standard deviation of the R-R interval of normal sinus beats(SDNN),standard deviation of the mean R-R interval for each 5 minutes(SDANN),the percentage of successive NN intervals>50 ms(pNN50)and mean of the standard deviations of all normal to normal intervals for all 5-min segments of the entire recording(SDNN index),cluster of differentiation 4^(+)(CD4^(+))cells,natural killing(NK)cells were significantly higher than those in the conventional treatment group,interleukin-6(IL-6),C-reactive protein(CRP),vascular endothelial growth factor(VEGF),tumor necrosis factor-α(TNF-α),and Cluster of differentiation 8^(+)(CD8^(+))cells were significantly lower than those in conventional treatment group(P<0.05).Conclusion:Glucocorticoid therapy is effective in the treatment of IVIG non-responsive KD children

关 键 词：糖皮质激素 人免疫球蛋白 阿司匹林 川崎病 免疫功能 

分 类 号：R72[医药卫生—儿科]