Yoo Jae Won, Kim Ji Mok, Kil Hong Ryang
Department of Pediatrics, Chungnam National University School of Medicine, Daejeon, Korea.
Korean J Pediatr. 2017 Jan;60(1):24-29. doi: 10.3345/kjp.2017.60.1.24. Epub 2017 Jan 24.
Previously, Kawasaki disease (KD) treatment with low-dose aspirin was administered for 6-8 weeks after the acute phase. However, inflammatory marker levels normalize before 6-8 weeks. In this study, we aimed to investigate the clinical outcome of short-term low-dose aspirin treatment based on inflammatory and thrombotic marker levels.
We performed a retrospective review of the medical records of patients with KD who were hospitalized at Chungnam National University Hospital between September 2012 and May 2014. When fever subsided, low-dose aspirin treatment was started. Inflammatory (white blood cell count, erythrocyte sedimentation rate, and C-reactive protein) and thrombotic markers (D-dimer) were monitored at follow-ups conducted in 1- to 2-week intervals. The low-dose aspirin administration was terminated when both markers were normalized and no cardiovascular complications were observed.
Eighty-four patients with KD (complete KD, n=49; incomplete KD, n=35) were enrolled. The inflammatory and thrombotic marker levels were normalized within 3-4 weeks on average. At the beginning the low-dose aspirin treatment, 9 patients had coronary artery lesions but 75 did not. When the low-dose aspirin administration was terminated at the time the inflammatory marker levels were normalized, no new CALs developed during the follow-up at 6-8 weeks.
Most of the inflammatory marker levels were normalized within 3-4 weeks after the acute phase of KD. New cardiovascular complications did not develop during the course of the short-term aspirin treatment based on the inflammatory marker levels, clinical findings, and echocardiography.
此前,川崎病(KD)在急性期后使用低剂量阿司匹林治疗6 - 8周。然而,炎症标志物水平在6 - 8周前就已恢复正常。在本研究中,我们旨在根据炎症和血栓形成标志物水平调查短期低剂量阿司匹林治疗的临床结果。
我们对2012年9月至2014年5月在忠南国立大学医院住院的KD患者的病历进行了回顾性研究。当发热消退时,开始低剂量阿司匹林治疗。在每隔1 - 2周进行的随访中监测炎症指标(白细胞计数、红细胞沉降率和C反应蛋白)和血栓形成标志物(D - 二聚体)。当两种标志物均恢复正常且未观察到心血管并发症时,停止低剂量阿司匹林给药。
纳入了84例KD患者(完全KD,n = 49;不完全KD,n = 35)。炎症和血栓形成标志物水平平均在3 - 4周内恢复正常。在开始低剂量阿司匹林治疗时,9例患者有冠状动脉病变,75例没有。当在炎症标志物水平恢复正常时停止低剂量阿司匹林给药,在6 - 8周的随访期间未出现新的冠状动脉病变。
大多数炎症标志物水平在KD急性期后3 - 4周内恢复正常。基于炎症标志物水平、临床发现和超声心动图,在短期阿司匹林治疗过程中未出现新的心血管并发症。