Objective To investigate the clinical results and changes in C-reactive protein(CRP),tumor necrosis factor-α (TNF-α) and inteukeukin-6 (IL-6) of patients with Kawasaki disease treated with gamma globulin combined with aspirin.Methods A total of 84 patients with Kawasaki disease were selected,which were treated in Central People's Hospital of Leshan City from Oct.2012 to Oct.2015,and were divided into an observation group(42 cases) and a control group (42 cases) by random number method.The control group was treated with vitamin E capsules [20 mg/(kg · d),14 d for continuous application] and dipyridamole tablets [5 mg/(kg · d)],aspirin [50 mg/(kg · d)],the dose reduced to 3-5 rng/(kg · d) when inflammatory response was controlled,body temperature to normal for 72 h,for eight weeks continuously.On the basis of the control group,the observation group was treated with gamma globulin (1 g/kg,continuous intravenous infusion of 8-12 h,during which a shock treatment was given).The improvement of clinical symptoms,including cervical lymph nodes subsiding time,foot swelling subsiding time,mucosal congestion subsiding time,defervescence time,the rash subsiding time,hospital stay were followed up for 3 to 6 months,changes of the levels of CRP,TNF-α,IL-6,white blood cell count(WBC),neutrophil ratio(NE),platelet count (PLT) of the two groups were observed and compared,and the artery lesions were observed.Results The cervical lymph nodes subsiding time,foot swelling subsiding time,mucosal congestion subsiding time,defervescence time,rash subsiding time,hospital stay time of the observation group were significantly less than those of the control group [(2.5 ± 1.2) d vs (4.5 ± 2.3) d,(3.9 ± 1.5) d vs (5.8 ± 3.0) d,(2.6 ± 1.4) d vs (4.4±2.3) d,(1.2±0.8) dvs (3.7±1.4) d,(3.8±1.1) dvs (6.5±4.2) d,(8.2 ±3.6) dvs (12.6±3.8) d,P ＜ 0.01].The levels of CRP,TNF-α,IL-6,WBC,NE,PLT of the observation group were significantly less than those of the control group[(22.4 ±5.2) rng/L vs (34.4 ±5.9) mg/L,(10.9 ±3.1) ng/L vs (15.8 ±6.3) ng/L,(7.2 ±2.1) ng/L vs (20.3 ±4.2) g/L,(9.4 ±5.1) × 109/L vs (12.2 ±5.1) × 109/L,(45.8 ± 11.3)％ vs (55.9 ± 14.1)％,(270.4 ± 94.5) × 109/L vs (210.6 ±92.3) × 109/L] (P ＜0.01).The incidence of coronary artery lesions of the two groups had no significant difference (P ＞ 0.05).Conclusion Treating patients with Kawasaki disease,gamma globulin combined with aspirin can obtain exact clinical results,significantly reduce the time of improvement of clinical symptoms,inhibit the release of inflammatory cytokines.%目的 探讨丙种球蛋白联合阿司匹林治疗川崎病患儿的临床效果及对C反应蛋白(CRP)、肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)水平的影响.方法 选择2012年10月至2015年10月乐山市市中区人民医院儿科收治84例川崎病患儿作为研究对象,按照随机数字法分为观察组和对照组,各42例.对照组给予维生素E胶囊20 mg/(kg·d),连续服用14 d;潘生丁片5 mg/(kg·d),阿司匹林50 mg/(kg·d),待炎症反应控制,体温正常72 h后,阿司匹林剂量减至3～5 mg/(kg·d),连续应用8周.观察组在对照组治疗基础上给予丙种球蛋白,持续静脉滴注1 g/kg,持续静脉滴注8～12h,同时在8～12 h内给予一次冲击治疗.观察两组患儿临床症状改善情况,包括颈淋巴结肿大消退时间、手足肿胀消退时间、黏膜充血消退时间、退热时间、皮疹消退时间、住院时间;比较治疗前后CRP、TNF-α、IL-6、白细胞计数(WBC)、中性粒细胞比值(NE)、血小板计数(PLT)水平;随访3～6个月,观察冠状动脉损害情况.结果 观察组在颈淋巴结肿大消退时间、手足肿胀消退时间、黏膜充血消退时间、退热时间、皮疹消退时间、住院时间均显著短于对照组[(2.5±1.2)d比(4.5±2.3)d、(3.9±1.5)d比(5.8±3.0)d、(2.6±1.4)d比(4.4±2.3)d、(1.2±0.8)d比(3.7±1.4)d、(3.8±1.1)d比(6.5±4.2)d、(8.2±3.6)d比(12.6±3.8)d,P＜0.01].治疗后CRP、TNF-α、IL-6、WBC、NE、PLT水平显著低于对照组[(22.4±5.2) mg/L比(34.4±5.9) mg/L,(10.9±3.1) ng/L比(15.8±6.3) ng/L,(7.2±2.1) ng/L比(20.3±4.2) g/L,(9.4±5.1)×109/L比(12.2±5.1)×109/L,(45.8±11.3)％比(55.9±14.1)％,(270.4±94.5)×109/L比(210.6±92.3)×109/L] (P＜0.01);随访3～6个月,两组患儿冠状动脉损害发生率差异无统计学意义(P＞0.05).结论 丙种球蛋白联合阿司匹林能有效缩短临床症状时间,有效抑制炎性细胞因子释放,疗效确切.
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