丙种球蛋白应用时间对川崎病患儿退热时间及冠状动脉损伤的影响

摘要

目的：探究丙种球蛋白不同应用时间对川崎病患儿退热时间及冠状动脉损伤的影响。方法回顾性分析2011年2月到2014年5月达州市中心医院儿科收治的144例川崎病患儿的临床资料，按照丙种球蛋白不同应用时间分为三组，早期组（43例）病程1～5 d，中期组（49例）病程6～10 d，晚期组（52例）病程＞10 d。对三组患儿治疗前后行血常规检测，记录患儿发热时间和临床症状消退时间，同时对比冠状动脉并发症发生率及对丙种球蛋白无反应性发生情况。结果在总发热时间上，晚期组患儿高于早期组和中期组[（10±5） d比（6±3） d、（8±3） d]，中期组高于早期组，差异有统计学意义（ P ＜0.05）；在丙种球蛋白无反应性方面，早期组高于中期组和晚期组[32.6％（14／43）比12.2％（6／49）、7.7％（4／52）]，差异有统计学意义（P ＜0.05）；在冠状动脉扩张发生方面，晚期组高于早期组和中期组[32.7％（17／52）比14.0％（6／43）、14.3％（7／49）]，差异有统计学意义（P＜0.05）；在冠状动脉瘤发生方面，晚期组高于早期组和中期组[34.6％（18／52）比11.6％（5／43）、14.3％（7／49）]，差异有统计学意义（P＜0.05）。治疗后，三组患儿的血小板计数、白细胞计数、C反应蛋白、红细胞沉降率均低于治疗前，差异有统计学意义（ P＜0.05）。结论在6～10 d使用丙种球蛋白治疗川崎病所需时间短，反应性高，且并发症可以耐受，值得推广。%Objective To explore the effect of different application time of gamma globulin to deferves-cence time and coronary artery damage of children with Kawasaki disease.Methods Total of 144 cases with Kawasaki disease admitted to Dazhou Central Hospital from Feb .2011 to May 2014 were included in the study and their clinical information was retrospectively analyzed.They were divided into three groups accord-ing to different application time of gamma globulin:early group (43 cases) 1-5 d of the disease duration, mid-term group(49 cases) 6-10 d of the disease duration,late group(52 cases) >10 d of the disease dura-tion,blood routine test before and after the treatment of the three groups was done,the fever time and clinical symptoms subsiding time were recorded,and the incidences of coronary artery complications and no-response to gamma globulin were compared.Results The total fever time of late group was longer than the early group and mid-term group[(10 ±5) d vs (6 ±3) d,(8 ±3) d],mid-term group was longer than the early group ( P<0.05);incidence of no response to the gamma globulin of the early group was higher than the mid-term group and late group[32.6%(14/43) vs 12.2%(6/49),7.7%(4/52)](P <0.05);coronary artery expansion incidence of the late group was higher than the early group and mid-term group[32.7%(17/52) vs 14.0%(6/43),14.3%(7/49)] (P<0.05); coronary artery aneurysm incidence of the late group was higher than the early group and mid-term group [34.6%(18/52) vs 11.6%(5/43),14.3%(7/49)] (P<0.05).After treatment,the platelet count,white blood cell count,C-reactive protein,erythrocyte sedi-mentation rate of the three groups were all lower than before treatment ,the differences were statistically signif-icant(P<0.05).Conclusion The application of gamma globulin in the treatment of Kawasaki disease dur-ing the 6-10 d of the disease course is featured with faster response time,high response,with tolerable compli-cations,thus is worthy of promotion.