| 摘要: |
| 目的：探讨氯吡格雷辅助治疗对丙种球蛋白无反应型川崎病患儿近期疗效、症状缓解时间及炎性因子指标水平的影响。方法：选取72例静脉注射丙种球蛋白无反应型川崎病患儿，随机分为观察组和对照组各36例。对照组采用阿司匹林联合双嘧达莫辅助丙种球蛋白急性治疗，观察组加用氯吡格雷，比较两组患儿的近期疗效、主要临床症状的缓解时间及治疗前后的白细胞计数（WBC）、血小板计数（PLT）、C反应蛋白（CRP）、降钙素原（PCT）、白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）、高迁移率族蛋白B1（HMGB1）、巨噬细胞移动抑制因子（MIF）的变化，比较两组患儿冠状动脉扩张、冠状动脉瘤以及不良反应发生率。结果：两组患儿总有效率的比较差异无统计学意义（P>0.05）；观察组患儿退热时间、颈部淋巴结肿大消退时间、黏膜弥漫性充血消退时间、躯干红斑缓解时间均显著少于对照组（P<0.05）；观察组治疗后的WBC、，PLT、CRP、PCT、IL-6、TNF-α、HMGB1、MIF水平均显著低于对照组（P<0.05）；观察组冠状动脉扩张发生率为8.33%，显著低于对照组（P<0.05）；两组患儿不良反应发生率比较差异无统计学意义（P>0.05）。结论：氯吡格雷辅助丙种球蛋白可提高静脉注射丙种球蛋白无反应型川崎病患儿的近期疗效，缩短临床症状的缓解时间，减轻机体的炎症反应和冠状动脉损伤，且具有良好的安全性。 |
| 关键词: 抗血小板方案 氯吡格雷 丙种球蛋白 川崎病 炎性因子 |
| DOI：10.13407/j.cnki.jpp.1672-108X.2021.02.008 |
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| 基金项目: |
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| Clinical Effects of Clopidogrel in Adjuvant Treatment of Children with Intravenous Immunoglobulin-Resistant Kawasaki Disease |
| Huang xiangyang, Zhang Qionghui |
| (Xiaochang First People’s Hospital, Hubei Xiaogan 432900, China) |
| Abstract: |
| Objective: To probe into the effects of clopidogrel treatment on short-term efficacy, relief time of symptoms and inflammatory factors in children with intravenous immunoglobulin-resistant Kawasaki disease. Methods: A total of 72 children with intravenous immunoglobulin-resistant Kawasaki disease were extracted to be divided into the observation group and the control group, with 36 cases in each group. The control group was treated with aspirin combined with dipyridamole-assisted gamma globulin, while the observation group received clopidogrel based on the control group. The short-term efficacy, relief time of symptoms, white blood cell count (WBC), platelet count (PLT), C-reactive protein (CRP), procalcitonin (PCT), interleukin-6 (IL-6), and tumor necrosis factor α (TNF-α), high mobility group protein B1 (HMGB1), and macrophage migration inhibitory factor (MIF) before and after treatment in two groups were compared. The incidence of coronary artery dilatation, coronary aneurysm and adverse drug reactions in two groups were analyzed. Results: There was no significant difference in the total effective rate between two groups (P>0.05). The duration of fever, disappearance time of enlargement of cervical lymph nodes, disappearance time of diffuse mucosal congestion and remission time of trunk erythema in the observation group were significantly shorter than those in the control group (P<0.05). The levels of WBC, PLT, CRP, PCT, IL-6, TNF-α, HMGB1 and MIF in the observation group after treatment were significantly lower than those in the control group (P<0.05). The incidence of coronary artery dilation in the observation group was 8.33%, significantly lower than that in the control group (P<0.05). There was no significant difference in the incidence of adverse drug reactions between two groups (P>0.05). Conclusion: Clopidogrel in adjuvant treatment of children with intravenous immunoglobulin-resistant Kawasaki disease can improve the short-term efficacy, shorten the relief time of symptoms and, reduce the inflammatory response and coronary artery injury with higher safety. |
| Key words: antiplatelet regimen clopidogrel gamma globulin Kawasaki disease inflammatory factors |
