阿司匹林在川崎病急性期治疗中最佳剂量的探讨

Discussion on the Optimal Dose of Aspirin in the Treatment of Acute Stage of Kawasaki’s Disease

关键词:  川崎病  阿司匹林  免疫球蛋白无反应  不同剂量

Key words:  Kawasaki’s disease  aspirin  non-response to intravenous human immunoglobulin  different doses

摘要:

目的 研究川崎病急性期采用不同剂量阿司匹林治疗对临床疗效的影响，探讨阿司匹林的最佳剂量方案。方法 利用医院信息系统随机抽取2022年3月—5月住院的150例川崎病病例进行回顾性分析。根据阿司匹林剂量不同分为3组：高剂量组(>50 mg·kg^?1·d^?1) 、中剂量组(30~50 mg·kg^?1·d^?1)和低剂量组(<30 mg·kg^?1·d^?1)。比较3组患儿退热时间、免疫球蛋白无反应发生率、实验室指标改善情况及不良反应发生率。结果 阿司匹林不同给药剂量下，3组患者体温恢复情况差异无统计学意义；患者出现免疫球蛋白无反应，3组间差异无统计学意义。治疗前，3组患儿的白细胞(white blood cell，WBC)计数、血小板(blood platelet，PLT)计数、C反应蛋白(C-reactive protein，CRP)计数比较，差异无统计学意义；治疗后，3组患儿WBC、PLT以及CRP计数均较治疗前明显改善，差异有统计学意义(P<0.05)；但治疗后3组患者的上述各项指标比较，差异无统计学意义。采用中、高剂量阿司匹林治疗，患儿出现不良反应的发生率更高。结论 免疫球蛋白联合不同剂量阿司匹林应用于川崎病均有较好的治疗效果，考虑到用药的安全性和经济性，建议采用低剂量给药方案。

Abstract:

OBJECTIVE To study the effect of different doses of aspirin on clinical efficacy in acute stage of Kawasaki’s disease, and to explore the optimal dose of aspirin. METHODS A total of 150 patients suffered from Kawasaki’s disease were randomly selected by hospital information system from March to May 2022 for retrospective analysis. According to different doses of aspirin, they were divided into three groups: high dose group(>50 mg·kg^?1·d^?1), medium dose group(30?50 mg·kg^?1·d^?1) and low dose group(<30 mg·kg^?1·d^?1). The antipyretic time, the incidence of non-response to intravenous human immunoglobulin, the improvement of laboratory indexes and prevalence of adverse drug reaction were compared among the three groups. RESULTS There was no significant difference in body temperature recovery among the three groups under different doses of aspirin. There was no significant difference in patients with non-response to intravenous human immunoglobulin among the three groups. Before treatment, there were no significant differences in white blood cell(WBC) count, blood platelet(PLT) count and C-reactive protein(CRP) concentration among the three groups. After treatment, the count of WBC, PLT and CRP in the three groups was significantly improved compared with that before treatment, and the difference was statistically significant(P<0.05). However, there was no significant difference in the above indexes among the three groups after treatment. There was a higher incidence of adverse reactions in children treated with medium or high dose aspirin. CONCLUSION Different doses of aspirin combined with intravenous human immunoglobulin have good therapeutic effect on Kawasaki’s disease, but considering the safety and economy of aspirin, low dose administration is recommended.