【摘要】 目的 探讨免疫球蛋白治疗川崎病合并心肌炎患者的临床疗效和安全性。方法 入选川崎病合并心肌炎患儿作为研究对象，分为对照组和试验组。对照组给予注射用甲泼尼龙琥珀酸钠，每次1～2 mg·min^-1,静脉滴注，连续用药3～7 d;试验组给予静脉滴注人免疫球蛋白，首次剂量：400 mg·kg^-1,维持剂量：200～400 mg·kg^-1,静脉滴注或以5%葡萄糖溶液稀释1～2倍作静脉滴注，连续用药3～7 d。比较2组患儿治疗结束时临床疗效、C反应蛋白（CRP）、红细胞沉降率、血小板计数、心肌酶、临床症状消失时间及药物不良反应的发生情况。结果 试验组和对照组分别纳入80例和70例。治疗后，试验组和对照组的总有效率分别为87.50%和74.28%,差异有统计学意义（P<0.05）。治疗后，试验组和对照组手足肿胀消退时间分别为（1.59±0.42）和（1.03±0.38） h,颈部淋巴结肿大消退时间分别为（3.72±1.28）和（2.37±1.03） h,发热消退时间分别为（2.74±1.42）和（2.01±0.94） h,黏膜充血消退时间分别为（6.72±1.22）和（5.05±1.15） h,血清CRP分别为（13.73±1.96）和（18.84±1.22） mg·L^-1,红细胞沉降率分别为（31.25±9.09）和（40.59±12.75） mm·h^-1,血小板计数分别为（246.37±12.73）和（289.14±10.38）×10⁹·L^-1,谷草转氨酶分别为（30.75±0.67）和（35.33±0.89）U·L^-1,乳酸脱氢酶分别为（205.33±14.35）和（212.32±10.21）U·L^-1,肌酸激酶分别为（201.11±16.36）和（219.15±18.55）U·L^-1,肌酸激酶同工酶MB分别为（29.65±2.98）和（33.15±2.16）U·L^-1,试验组上述指标与对照组比较，差异均有统计学意义（均P<0.05）。试验组和对照组发生的药物不良反应主要有出血、黑便、哮喘、肝肾功能损伤和食欲缺乏，试验组和对照组的总药物不良反应发生率分别为30.00%和58.58%,差异无统计学意义（P>0.05）。结论 免疫球蛋白比甲泼尼龙治疗川崎病合并心肌炎患儿临床疗效更佳，值得临床应用。更多还原

【Abstract】 Objective To explore the efficacy and safety of immunoglobulin in the treatment of Kawasaki disease complicated with myocarditis. Methods Kawasaki disease children with myocarditis were selected as the research subjects and divided into control group and treatment group. The control group received intravenous injection of methylprednisolone sodium succinate at a dose of 1～2 mg·min^-1, continuous infusion for 3～7 days. The treatment group received intravenous immunoglobulin, with an initial dose of 400 mg·kg^-1 and a maintenance dose of 200～400 mg·kg^-1. It was administered as an intravenous infusion or diluted 1-2 times with 5% glucose solution and administered as an intravenous infusion for 3 ～7 days. The clinical efficacy,C-reactive protein（ CRP）,erythrocyte sedimentation rate,platelet count,myocardial enzymes,time to disappearance of clinical symptoms,and occurrence of adverse drug reactions were compared between the two groups at the end of treatment. Results A total of 80 cases and 70 cases were included in the treatment group and control group,respectively. After treatment,the total effective rates of the treatment group and control group were87. 50% and 74. 28%,respectively,with statistically significant difference（ P < 0. 05）. The time for resolution of hand-foot swelling in the treatment group and control group were（ 1. 59 ± 0. 42） and（ 1. 03 ± 0. 38） h,respectively;the time for resolution of cervical lymphadenopathy were（ 3. 72 ± 1. 28） and（ 2. 37 ± 1. 03） h,respectively; the time for fever resolution were（ 2. 74 ± 1. 42） hours and（ 2. 01 ± 0. 94） h,respectively; the time for resolution of mucosal congestion were（ 6. 72 ± 1. 22） and（ 5. 05 ± 1. 15） h,respectively; the serum CRP levels were（ 13. 73 ± 1. 96） and（ 18. 84 ± 1. 22） mg·L^-1,respectively; the erythrocyte sedimentation rate were（ 31. 25 ± 9. 09） and（ 40. 59 ± 12. 75）mm·h^-1,respectively; the platelet count were（ 246. 37 ± 12. 73） and（ 289. 14 ± 10. 38） × 10⁹·L^-1,respectively;the glutamic oxalacetic transaminase levels were（ 30. 75 ± 0. 67） and（ 35. 33 ± 0. 89） U · L^-1,respectively; the lactate dehydrogenase levels were（ 205. 33 ± 14. 35） and（ 212. 32 ± 10. 21） U · L^-1,respectively; the creatine kinase levels were（ 201. 11 ± 16. 36） and（ 219. 15 ± 18. 55） U·L^-1,respectively; the creatine kinase isoenzyme MB levels were（ 29. 65 ± 2. 98） and（ 33. 15 ± 2. 16） U · L^-1,respectively. The differences in the above indicators between the treatment group and control group were statistically significant（ all P < 0. 05）. The main adverse drug reactions observed in the treatment group and control group were bleeding,black stool,asthma,liver and kidney function injury,and loss of appetite. The incidence rates of adverse drug reactions in the treatment group and control group were 30. 00% and 58. 58%, respectively, with no significant difference（ P > 0. 05）. Conclusion Immunoglobulin has better clinical efficacy than methylprednisolone in the treatment of Kawasaki disease complicated with myocarditis in children and is worthy of clinical application.更多还原