用甲氨蝶呤治疗静脉注射免疫球蛋白抵抗性川崎病。

Treatment of intravenous immunoglobulin-resistant Kawasaki disease with methotrexate.

作者信息

Ahn S Y, Kim D S

机构信息

Department of Paediatrics, College of Medicine, Yonsei University, Seoul, Korea.

出版信息

Scand J Rheumatol. 2005 Mar-Apr;34(2):136-9. doi: 10.1080/03009740510026328.

DOI:10.1080/03009740510026328

PMID:16095010

Abstract

OBJECTIVE

To evaluate the effect of low-dose oral methotrexate (MTX) as treatment for patients with Kawasaki disease (KD) resistant to intravenous immunoglobulin (IVIG).

METHODS

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)].

RESULTS

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.

CONCLUSION

Low-dose oral MTX is an effective treatment for refractory KD.

摘要

目的

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。

方法

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）]。