Aspirin Dose and Treatment Outcomes in Kawasaki Disease: A Historical Control Study in Japan
Aspirin Dose and Treatment Outcomes in Kawasaki Disease: A Historical Control Study in Japan
复制标题
DOI：
10.3389/fped.2020.00249
复制
发表时间：
2020-05-14
影响因子：
2.6
通讯作者：
Hamada, Hiromichi
中科院分区：
文献类型：
--
作者：
Ito, Yu;Matsui, Takuya;Hamada, Hiromichi
阿司匹林已被用作治疗川崎（KD）的伴随药物。近年来，一直在讨论大剂量阿司匹林是否适用于KD急性期的治疗。我们回顾性研究了冠状动脉异常（CAA）的发生率和30至50 mg/kg/天阿司匹林（日本批准的最小和最大剂量）的解热作用。这是一项单中心、非随机、回顾性、历史队列研究。患者在2007年至2014年4月期间常规接受50 mg/kg/天阿司匹林（50 mg组）治疗，并在2014年5月至2016年期间接受30 mg/kg/天阿司匹林（30 mg组）治疗。所有患者均接受初始静脉注射免疫球蛋白（IVIG）2.0 g/kg，如有必要，随后进行静脉注射。主要终点是CA的发生率，定义为治疗第4周时Z评分≥ 2.5的CA直径。次要终点是进一步治疗的发生率。使用调整年龄、性别和风险评分的逆概率加权分析比较发生率。在587例患者中，CAA的发生率无显著差异（30 mg组的比值比为0.769，95%置信区间（CI）：0.537- 1.101，p = 0.151）。首次IVIG后30 mg组进一步治疗的风险显著高于50 mg组（优势比1.379，95%CI：1.051- 1.811，p = 0.021）。虽然这项研究有一些局限性，但结果表明，与30 mg/kg/天相比，阿司匹林50 mg/kg/天可能对改善CAA的发生率没有显著影响，但进一步治疗的比例可能较低。
Aspirin has been used as a concomitant drug in the treatment of Kawasaki disease (KD). In recent years, there has been discussion concerning whether high-dose aspirin is appropriate for treatment in the acute phase of KD. We retrospectively investigated the incidence of coronary artery abnormalities (CAAs) and the antipyretic effect of 30 to 50 mg/kg/day aspirin, the minimum and the maximum approved doses in Japan. This was a single-center, non-randomized, retrospective, historical cohort study. Patients were routinely treated with 50 mg/kg/day aspirin (50-mg Group) between 2007 and April 2014, and with 30 mg/kg/day aspirin (30-mg Group) between May 2014 and 2016. All patients were given initial and, if necessary, subsequent intravenous immunoglobulin (IVIG) 2.0 g/kg. The primary endpoint was incidence of CAAs defined as a CA diameter with a Z score >= 2.5 at treatment week 4. The secondary endpoint was incidence of further treatment. Incidences were compared using inverse probability weighting analysis adjusting for age, sex, and risk scores. In 587 patients, there was no significant difference in incidence of CAAs (odds ratio in 30-mg Group 0.769, 95% confidence interval (CI): 0.537-1.101,p= 0.151). Risk of further treatment after the first IVIG in the 30-mg Group was significantly higher than that in the 50-mg Group (odds ratio 1.379, 95% CI: 1.051-1.811,p= 0.021). Although this study has some limitations, the findings suggest that aspirin 50 mg/kg/day may have no significant effect on improving incidence of CAAs compared with 30 mg/kg/day but may have a lower rate of further treatment.