Ahn S Y, Kim D S
Department of Paediatrics, College of Medicine, Yonsei University, Seoul, Korea.
Scand J Rheumatol. 2005 Mar-Apr;34(2):136-9. doi: 10.1080/03009740510026328.
To evaluate the effect of low-dose oral methotrexate (MTX) as treatment for patients with Kawasaki disease (KD) resistant to intravenous immunoglobulin (IVIG).
The subjects were four patients with KD, aged 8 months to 8 years old, who showed persistent disease after treatment with high-dose IVIG (2 g/kg) and aspirin (100 mg/kg). These patients were re-treated with IVIG and were also treated with IV dexamethasone (0.3 mg/kg). IV dexamethasone induced defervescence in three patients, but fever recurred upon discontinuing the steroid. One patient showed no response to either IVIG or dexamethasone. All patients were subsequently treated weekly with low-dose oral MTX [10 mg/body surface area (BSA)].
MTX treatment resulted in rapid defervescence, improvement in clinical symptoms, and normalization of acute-phase reactants in all patients. There was no progression of coronary artery dilatation and MTX was discontinued with no recurrence of fever. No adverse effects of MTX were observed.
Low-dose oral MTX is an effective treatment for refractory KD.
评估低剂量口服甲氨蝶呤（MTX）对静脉注射免疫球蛋白（IVIG）治疗无效的川崎病（KD）患者的治疗效果。
研究对象为4例KD患儿，年龄8个月至8岁，在接受大剂量IVIG（2 g/kg）和阿司匹林（100 mg/kg）治疗后病情仍持续存在。这些患者再次接受IVIG治疗，并同时接受静脉注射地塞米松（0.3 mg/kg）治疗。静脉注射地塞米松使3例患者退热，但停用类固醇后发热复发。1例患者对IVIG和地塞米松均无反应。所有患者随后每周接受低剂量口服MTX治疗[10 mg/体表面积（BSA）]。
MTX治疗使所有患者迅速退热，临床症状改善，急性期反应物恢复正常。冠状动脉扩张无进展，停用MTX后无发热复发。未观察到MTX的不良反应。
低剂量口服MTX是治疗难治性KD的有效方法。
