Efficacy of intravenous immune globulin therapy combined with dexamethasone for the initial treatment of acute Kawasaki disease
Efficacy of intravenous immune globulin therapy combined with dexamethasone for the initial treatment of acute Kawasaki disease
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DOI：
10.1007/s00431-003-1386-5
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发表时间：
2004-04-01
影响因子：
3.6
通讯作者：
Kohno, Y
中科院分区：
文献类型：
--
作者：
Jibiki, T;Terai, M;Kohno, Y
目的：探讨静脉注射免疫球蛋白(IVIG)联合地塞米松(DEX)治疗川崎病(KD)的临床疗效及对血清血管内皮生长因子(VEGF)水平的影响。46例KD患者接受地塞米松0.3 mg/kg/d加肝素静脉滴注。地塞米松组(DEX组)，连续3d，静脉注射丙种球蛋白2g/kg，连用4~5d。地塞米松治疗结束后开始小剂量乙酰水杨酸治疗。对照组46例，早期给予静脉注射丙种球蛋白2g/kg，疗程4~5d，加大剂量乙酰水杨酸(对照组)。两组均未发现严重不良反应。除C-反应蛋白外，两组间基线和治疗后实验室数据均无差异。地塞米松组治疗后C反应蛋白(中位数0.9 mg/dl，0~24.7 mg/dl)低于对照组(1.2 mg/dl，0.2~19.5 mg/dl，经Mann-Whitney U检验，P=0.033)。首次静脉注射丙种球蛋白后，地塞米松组发热持续时间平均为2.2d(中位数1d，范围1~12d)，对照组为2.8d(2d，1~16d)(经Mann-Whitney U检验，P=0.015)。新的方案没有降低血管内皮生长因子的水平。每组中有两名患者出现了小型或中型冠状动脉动脉瘤。结论：免疫球蛋白联合地塞米松早期治疗川崎病是安全的，可加速全身炎症的消退，但不影响冠脉预后。
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. Conclusion: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.