Effect of different doses of aspirin on the prognosis of Kawasaki disease

摘要

BACKGROUND:Kawasaki disease (KD) is the leading cause of acquired heart disease in children, and is steadily increasing in prevalence in East Asia. KD is often complicated by coronary artery damage, including dilatation and/or aneurysms. Aspirin is used with intravenous immunoglobulin (IVIG) to prevent coronary artery abnormalities in KD. However, the role and optimal dose of aspirin remain controversial. Identifying the dose of aspirin in the acute phase will facilitate development of a more appropriate treatment strategy in improving the outcome of KD.METHODS:A total of 2369 patients with KD were retrospectively analyzed and divided into three groups according to the aspirin dose: 510 in group 1 (20-29?mg/kg/day), 1487 in group 2 (30-39?mg/kg/day), and 372 in group 3 (40-50?mg/kg/day). The differences in laboratory data, rate of IVIG resistance and coronary artery damage were compared among the groups.RESULTS:There was no difference in the incidence of coronary artery aneurysms (CAAs) in group 1 compared with groups 2 and 3 (2?weeks of illness: 2.94% vs. 1.90% vs. 3.36%; 3-4?weeks of illness: 1.94% vs. 2.32% vs. 2.65%). The risk for developing CAA was not reduced at 2?weeks of illness onset in groups 2 and 3 compared with group 1 (adjusted OR?=?1.05, 95% confidence interval: 0.34-3.18; aOR?=?1.81, 95% CI: 0.42-7.83). Furthermore, the risk for developing CAA was not reduced at 3-4?weeks of illness onset in groups 2 and 3 (aOR?=?2.63, 95% CI: 0.61-11.28; aOR?=?0.52, 95% CI: 0.03-9.54). There was no significant difference in the rate of IVIG resistance among the groups. Platelet levels after IVIG treatment in group 1 were significantly lower than those in groups 2 and 3 (522.29?×?10sup9/sup/L, 544.69?×?10sup9/sup/L, and 557.77?×?10sup9/sup/L, p?=?0.013). C reactive protein of the 30-40?mg/kg*day group was slightly higher than the other two groups. (7.76, 8.00, and 7.01?mg/L, p?=?0.028).CONCLUSIONS:Aspirin at the dose of 20-29?mg/kg/day dose not increase the risk of coronary artery damage and IVIG resistance compared with the dose of 30-50?mg/kg/day. This low dose may have a lower risk for a potential effect on liver function.