糖皮质激素联合乌司他丁治疗小儿川崎病的短期疗效
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摘要
目的观察糖皮质激素联合乌司他丁治疗小儿川崎病的短期疗效。方法选取82例川崎病患儿,根据患儿家属意愿分为观察组(n=44)与对照组(n=38)。观察组采取糖皮质激素联合乌司他丁治疗,对照组采取阿司匹林联合大剂量静脉注射丙种球蛋白(IVIG)治疗。比较2组治疗前后的冠状动脉内径分级、治疗24和48h的体温恢复情况,治疗前及治疗后1周的血清C反应蛋白(CRP)、血小板计数(PLT)、血沉(ESR)和外周血白细胞(WBC)水平,住院花费及药品花费。结果治疗前,2组的冠状动脉内径分别为2.97±0.81和2.89±0.90mm,差异无统计学意义。治疗8周后,观察组冠状动脉内径减小至2.51±0.74mm,对照组减小至2.55±0.51mm,治疗前后差异均有统计学意义(t=2.781,P=0.007;t=2.026,P=0.046)。2组治疗前后的冠状动脉内径分级差异均无统计学意义(P>0.05)。观察组治疗48h内退热率为100%,显著高于对照组的86.84%(P<0.05)。观察组退热时间、住院花费与药品花费分别为17.52±4.20h、0.73±0.18万元和0.33±0.09万元,显著低于对照组26.41±5.94h、1.08±0.23万元和0.68±0.13万元(P<0.05)。2组治疗后1周及2周的血清CRP和ESR均较治疗前显著降低(P<0.05),PLT较治疗前显著升高(P<0.05)。观察组治疗后1周及2周的ESR显著低于对照组(P<0.05),WBC显著高于对照组(P<0.05)。结论糖皮质激素联合乌司他丁治疗小儿川崎病与IVIG短期疗效相当,且患儿退热更快,与IVIG相比住院花费与药物花费大幅减少,经济性高。
Objective To observe the short-term efficacy of glucocorticoid combined with ulinastatin in children with Kawasaki disease.Methods A total of 82 children with Kawasaki disease were selected and divided into observation group(n=44)and control group(n=38)according to the will of family members.The observation group received glucocorticoid combined with ulinastatin for treatment,while the control group was treated with aspirin combined with high-dose intravenous gamma globulin(IVIG).The coronary artery diameter grading before treatment and 8weeks after treatment,the body temperature recovery of treatment for 24 and 48h,the levels of C-reactive protein(CRP),Platelet count(PLT),erythrocyte sedimentation rate(ESR)and peripheral white blood cells(WBC)before treatment and 1week after treatment,the hospitalization costs and drug costs were compared between the 2groups.Results There was no statistically significant difference in the coronary artery diameter between the observation group and the control group 2.97±0.81 vs 2.89±0.90 mm before treatment(P<0.05).At the 8th week after treatment,the coronary artery diameter was reduced to 2.51±0.74 mm in the observation group and 2.55±0.51 mm in the control group.The difference was statistically significant(t=2.781,P=0.007;t=2.026,P=0.046).There was no significant difference in coronary artery diameter grading between the 2groups before and after treatment(P>0.05).The evacuation rate was 100%in the observation group at 48 hafter treatment,which was significantly higher than 86.84%in the control group(P<0.05).The body temperature recovery time,hospitalization costs and drug costs were 17.52±4.20 h,0.73±0.18 million and 0.33±0.09 million in the observation group,which significantly lower than 26.41±5.94 h,1.08±0.23 million and 0.68±0.13 million in control group(P<0.05).The levels of serum CRP and ESR of the 2groups after treatment were significantly lower than those before treatment(P<0.05).The levels of PLT of the 2groups were significantly higher than those before treatment(P<0.05).The levels of ESR at 1week and 2weeks after treatment were significantly lower than those in the control group(P<0.05),WBC was significantly higher than those in the control group(P<0.05).Conclusion The glucocorticoid combined with ulinastatin in children with Kawasaki disease can achieve the similar short-term efficacy to IVIG with the characteristics of faster antipyretic,lower drug costs and shorter hospitalization.
Objective To observe the short-term efficacy of glucocorticoid combined with ulinastatin in children with Kawasaki disease.Methods A total of 82 children with Kawasaki disease were selected and divided into observation group(n=44)and control group(n=38)according to the will of family members.The observation group received glucocorticoid combined with ulinastatin for treatment,while the control group was treated with aspirin combined with high-dose intravenous gamma globulin(IVIG).The coronary artery diameter grading before treatment and 8weeks after treatment,the body temperature recovery of treatment for 24 and 48h,the levels of C-reactive protein(CRP),Platelet count(PLT),erythrocyte sedimentation rate(ESR)and peripheral white blood cells(WBC)before treatment and 1week after treatment,the hospitalization costs and drug costs were compared between the 2groups.Results There was no statistically significant difference in the coronary artery diameter between the observation group and the control group 2.97±0.81 vs 2.89±0.90 mm before treatment(P<0.05).At the 8th week after treatment,the coronary artery diameter was reduced to 2.51±0.74 mm in the observation group and 2.55±0.51 mm in the control group.The difference was statistically significant(t=2.781,P=0.007;t=2.026,P=0.046).There was no significant difference in coronary artery diameter grading between the 2groups before and after treatment(P>0.05).The evacuation rate was 100%in the observation group at 48 hafter treatment,which was significantly higher than 86.84%in the control group(P<0.05).The body temperature recovery time,hospitalization costs and drug costs were 17.52±4.20 h,0.73±0.18 million and 0.33±0.09 million in the observation group,which significantly lower than 26.41±5.94 h,1.08±0.23 million and 0.68±0.13 million in control group(P<0.05).The levels of serum CRP and ESR of the 2groups after treatment were significantly lower than those before treatment(P<0.05).The levels of PLT of the 2groups were significantly higher than those before treatment(P<0.05).The levels of ESR at 1week and 2weeks after treatment were significantly lower than those in the control group(P<0.05),WBC was significantly higher than those in the control group(P<0.05).Conclusion The glucocorticoid combined with ulinastatin in children with Kawasaki disease can achieve the similar short-term efficacy to IVIG with the characteristics of faster antipyretic,lower drug costs and shorter hospitalization.
引文
[1]李晓惠.川崎病诊断与治疗新进展[J].中华实用儿科临床杂志,2013,28(1):9-13.
[2]付培培,杜忠东,潘岳松,等.2002-2010年北京儿童医院川崎病住院患儿临床分析[J].实用儿科临床杂志,2012,27(9):661-664.
[3]谢利剑,周翠臻,王韧健,等.基于电子数据采集系统的川崎病602例回顾性分析[J].中华儿科杂志,2015,53(1):34-39.
[4]王从军,雷中劲.川崎病患儿对静脉注射免疫球蛋白治疗反应的病例对照研究[J].实用医学杂志,2015,31(16):2651-2654.
[5]杜军保.川崎病的诊断与鉴别诊断[J].中国实用儿科杂志,2006,21(10):727-728.
[6]杨莹,张静.激素与静脉丙种球蛋白及其联合应用治疗静脉丙种球蛋白无反应川崎病的回顾性对照研究[J].中国循证儿科杂志,2016,11(4):265-269.
[7]张敏,胡秀芬.丙种球蛋白无反应型川崎病研究进展[J].中华实用儿科临床杂志,2013,28(21):1672-1676.
[8]张晗.激素治疗川崎病的研究进展[J].国际儿科学杂志,2013,40(4):367-370.
[9]张晓梅,张利,刘德滢,等.川崎病患儿787例冠状动脉病变情况随访[J].中华风湿病学杂志,2014,18(9):636-639.
[10]李华斌,罗菲菲,蒋莉,等.糖皮质激素治疗降低川崎病患儿冠状动脉病变发生风险的Meta分析[J].重庆医学,2015,44(3):356-358.
[11]朱瑶丽,朱春丽,王小华,等.乌司他丁对脓毒症休克患者血常规、血乳酸及降钙素原的影响[J].西北药学杂志,2015,30(5):618-620.
[12]Kawamura Y,Kanai T,Takeshita S,et al.Use of the urinary trypsin inhibitor ulinastatin for acute Kawasaki disease[J].Nihon Rinsho,2014,72(9):1650-1653.
[13]余莉,王一斌,乔莉娜,等.川崎病并发冠状动脉损伤的危险因素分析[J].中华妇幼临床医学杂志:电子版,2015,11(2):96-99.
[14]Kanai T,Ishiwata T,Kobayashi T,et al.Ulinastatin,a urinary trypsin inhibitor,for the initial treatment of patients with Kawasaki disease:a retrospective study[J].Circulation,2011,124(25):2822-2828.
[15]江彦秋,黄先玫.川崎病的免疫与遗传学发病机制研究进展[J].中华实用儿科临床杂志,2017,32(9):717-720.
[16]赵春娜,杜忠东.感染因素对川崎病及其冠状动脉病变的影响[J].中国循证儿科杂志,2015,10(6):454-457.
[17]张永为,沈捷,黄敏,等.标准治疗方案联合糖皮质激素对川崎病冠状动脉瘤发生率影响的Meta分析[J].中国循证儿科杂志,2010,5(6):418-423.
[18]王晓旭,王晓楠,王文超,等.川崎病患儿血清脑利钠肽、心型脂肪酸结合蛋白的变化及其与心功能的关系[J].中华实用儿科临床杂志,2017,32(9):705-707.
[19]张晓燕,吴守振,刘春风,等.川崎病患者糖皮质激素受体、IL-17A、IL-6检测的临床意义[J].陕西医学杂志,2016,45(10):1392-1393,1421.
[20]白雪艳,张静,钟家蓉,等.再次应用静脉丙种球蛋白无反应川崎病的预测因素分析[J].中国循证儿科杂志,2016,11(1):17-20.
[21]李静,王博龙,冯瑞冰,等.糖皮质激素联合免疫球蛋白用于川崎病初始治疗有效性的Meta分析[J].中国当代儿科杂志,2016,18(6):527-533.
[2]付培培,杜忠东,潘岳松,等.2002-2010年北京儿童医院川崎病住院患儿临床分析[J].实用儿科临床杂志,2012,27(9):661-664.
[3]谢利剑,周翠臻,王韧健,等.基于电子数据采集系统的川崎病602例回顾性分析[J].中华儿科杂志,2015,53(1):34-39.
[4]王从军,雷中劲.川崎病患儿对静脉注射免疫球蛋白治疗反应的病例对照研究[J].实用医学杂志,2015,31(16):2651-2654.
[5]杜军保.川崎病的诊断与鉴别诊断[J].中国实用儿科杂志,2006,21(10):727-728.
[6]杨莹,张静.激素与静脉丙种球蛋白及其联合应用治疗静脉丙种球蛋白无反应川崎病的回顾性对照研究[J].中国循证儿科杂志,2016,11(4):265-269.
[7]张敏,胡秀芬.丙种球蛋白无反应型川崎病研究进展[J].中华实用儿科临床杂志,2013,28(21):1672-1676.
[8]张晗.激素治疗川崎病的研究进展[J].国际儿科学杂志,2013,40(4):367-370.
[9]张晓梅,张利,刘德滢,等.川崎病患儿787例冠状动脉病变情况随访[J].中华风湿病学杂志,2014,18(9):636-639.
[10]李华斌,罗菲菲,蒋莉,等.糖皮质激素治疗降低川崎病患儿冠状动脉病变发生风险的Meta分析[J].重庆医学,2015,44(3):356-358.
[11]朱瑶丽,朱春丽,王小华,等.乌司他丁对脓毒症休克患者血常规、血乳酸及降钙素原的影响[J].西北药学杂志,2015,30(5):618-620.
[12]Kawamura Y,Kanai T,Takeshita S,et al.Use of the urinary trypsin inhibitor ulinastatin for acute Kawasaki disease[J].Nihon Rinsho,2014,72(9):1650-1653.
[13]余莉,王一斌,乔莉娜,等.川崎病并发冠状动脉损伤的危险因素分析[J].中华妇幼临床医学杂志:电子版,2015,11(2):96-99.
[14]Kanai T,Ishiwata T,Kobayashi T,et al.Ulinastatin,a urinary trypsin inhibitor,for the initial treatment of patients with Kawasaki disease:a retrospective study[J].Circulation,2011,124(25):2822-2828.
[15]江彦秋,黄先玫.川崎病的免疫与遗传学发病机制研究进展[J].中华实用儿科临床杂志,2017,32(9):717-720.
[16]赵春娜,杜忠东.感染因素对川崎病及其冠状动脉病变的影响[J].中国循证儿科杂志,2015,10(6):454-457.
[17]张永为,沈捷,黄敏,等.标准治疗方案联合糖皮质激素对川崎病冠状动脉瘤发生率影响的Meta分析[J].中国循证儿科杂志,2010,5(6):418-423.
[18]王晓旭,王晓楠,王文超,等.川崎病患儿血清脑利钠肽、心型脂肪酸结合蛋白的变化及其与心功能的关系[J].中华实用儿科临床杂志,2017,32(9):705-707.
[19]张晓燕,吴守振,刘春风,等.川崎病患者糖皮质激素受体、IL-17A、IL-6检测的临床意义[J].陕西医学杂志,2016,45(10):1392-1393,1421.
[20]白雪艳,张静,钟家蓉,等.再次应用静脉丙种球蛋白无反应川崎病的预测因素分析[J].中国循证儿科杂志,2016,11(1):17-20.
[21]李静,王博龙,冯瑞冰,等.糖皮质激素联合免疫球蛋白用于川崎病初始治疗有效性的Meta分析[J].中国当代儿科杂志,2016,18(6):527-533.