Jibiki Toshiaki, Terai Masaru, Kurosaki Tomomichi, Nakajima Hiromichi, Suzuki Kazuhiro, Inomata Hiroaki, Terashima Itaru, Honda Takafumi, Yasukawa Kumi, Hamada Hiromichi, Kohno Yoichi
Department of Paediatrics, Chiba Municipal Kaihin Hospital, Chiba, Japan.
Eur J Pediatr. 2004 Apr;163(4-5):229-33. doi: 10.1007/s00431-003-1386-5. Epub 2004 Feb 13.
We studied the effects of a new regimen consisting of intravenous immune globulin (IVIG) combined with dexamethasone (DEX) on clinical outcome and serum levels of vascular endothelial growth factor (VEGF) in the initial treatment of Kawasaki disease (KD). A total of 46 KD patients received 0.3 mg/kg per day DEX plus heparin i.v. for 3 consecutive days, together with 2 g/kg IVIG over 4 to 5 days (DEX group). Low-dose acetylsalicylic acid was started after completion of DEX therapy. The control group consisted of 46 KD patients retrospectively treated earlier with 2 g/kg IVIG over 4 to 5 days plus higher dose acetylsalicylic acid (CONTROL group). No serious adverse effect was noted in either group. There were no differences in baseline and post-treatment laboratory data except for C-reactive protein between the groups. Post-treatment C-reactive protein in the DEX group (median 0.9 mg/dl, range 0.0 to 24.7 mg/dl) was lower than that (1.2 mg/dl, range 0.2 to 19.5 mg/dl) in the CONTROL group ( P=0.033 by Mann-Whitney U test). In addition, the mean duration of fever after the first IVIG infusion was 2.2 days (median 1 day, range 1 to 12 days) in the DEX group and 2.8 days (2 days, 1 to 16 days) in the CONTROL group ( P=0.015 by Mann-Whitney U test). The new regimen did not reduce VEGF levels. Two patients in each group developed small- or medium-sized coronary artery aneurysms.
Although this regimen did not affect coronary outcome, intravenous immune globulin therapy combined with dexamethasone for the initial treatment of Kawasaki disease was safe and may accelerate the resolution of systemic inflammation.
我们研究了一种由静脉注射免疫球蛋白（IVIG）联合地塞米松（DEX）组成的新方案对川崎病（KD）初始治疗的临床结局及血管内皮生长因子（VEGF）血清水平的影响。总共46例KD患者接受每日0.3mg/kg的DEX加静脉注射肝素，连续3天，同时在4至5天内给予2g/kg的IVIG（DEX组）。DEX治疗结束后开始使用低剂量阿司匹林。对照组由46例KD患者组成，这些患者回顾性分析显示早期接受了4至5天内2g/kg的IVIG加更高剂量的阿司匹林治疗（对照组）。两组均未观察到严重不良反应。除了两组之间的C反应蛋白外，基线和治疗后实验室数据无差异。DEX组治疗后的C反应蛋白（中位数0.9mg/dl，范围0.0至24.7mg/dl）低于对照组（1.2mg/dl，范围0.2至19.5mg/dl）（曼-惠特尼U检验，P = 0.033）。此外，DEX组首次输注IVIG后发热的平均持续时间为2.2天（中位数1天，范围1至12天），对照组为2.8天（2天；1至16天）（曼-惠特尼U检验，P = 0.015）。新方案未降低VEGF水平。每组有2例患者发生中小冠状动脉瘤。
虽然该方案不影响冠状动脉结局，但静脉注射免疫球蛋白联合地塞米松用于川崎病的初始治疗是安全的，且可能加速全身炎症的消退。
