【摘要】 目的：探讨糖皮质激素联合人免疫球蛋白治疗川崎病(KD)患儿的疗效及对外周血辅助性T淋巴细胞(Th)1、Th2及生长分化因子-15(GDF-15)水平的影响。方法：选择2018年1月至2021年1月于该院儿科就诊的83例KD患儿为观察对象，按住院号单双号分为联合组(n=42)与对照组(n=41),均接受人免疫球蛋白+阿司匹林治疗，联合组患儿在此基础上加用糖皮质激素治疗。治疗1周后评估疗效，统计两组患儿的发热时间、人免疫球蛋白注射时间、住院时间和住院花费；检测治疗前、治疗1周后的实验室指标(白细胞计数、血小板计数、红细胞压积、C反应蛋白、血清白蛋白、总胆红素和直接胆红素)水平的变化；检测治疗前后Th1/Th2细胞比例、GDF-15水平的变化；统计两组患儿尿路感染、心电图异常及血糖紊乱等不良反应发生率。结果：联合组患儿的总有效率为90.48%(38/42),高于对照组的73.17%(30/41),差异有统计学意义(χ~2=4.196,P=0.041)。联合组患儿的发热时间、人免疫球蛋白注射时间和住院时间短于对照组(t分别为-3.924、-3.644和-3.644,P均<0.01),住院花费少于对照组(t=-11.871,P<0.01),差异均有统计学意义。两组患儿实验室指标水平治疗前后差值比较，差异无统计学意义(P>0.05)。治疗1周后，联合组患儿的Th1细胞比例、Th1/Th2比值高于对照组，Th2细胞比例、GDF-15水平低于对照组(P<0.05);联合组患儿治疗前后Th1、Th2和Th1/Th2差值高于对照组(P<0.05),差异均有统计学意义。对照组、联合组患儿总不良反应发生率分别为26.83%(11/41)、21.43%(9/42),差异无统计学意义(χ~2=0.331,P=0.565)。结论：糖皮质激素联合人免疫球蛋白治疗KD患儿的整体效果优于单用人免疫球蛋白，可改善患儿Th2细胞活化，维持Th1/Th2平衡，降低GDF-15水平。更多还原

【Abstract】 OBJECTIVE: To analyze the efficacy of glucocorticoid combined with human immunoglobulin in the treatment of children with Kawasaki disease(KD) and its effects on helper T lymphocyte(Th) 1/Th2 and growth differentiation factor-15(GDF-15) levels in peripheral blood. METHODS: Totally 83 children with KD admitted into the pediatrics department in this hospital from Jan. 2018 to Jan. 2021 were selected as observation subjects and were divided into the combination group(42 cases) and control group(41 cases) according to the odd or even admission number, both groups were given human immunoglobulin+ aspirin, while the combination group was treated with glucocorticoid based on that basis. The efficacy was evaluated after 1 week of treatment, the durations of fever, duration of human immunoglobulin injection, lengths of stay and hospital costs of both groups were collected; the changes of laboratory indexes(white blood cell count, platelet count, hematokrit, C-reactive protein, serum albumin, total bilirubin and direct bilirubin) were measured before treatment and after 1 week of treatment; the changes of Th1/Th2 cell ratio and GDF-15 level were detected before and after treatment; the incidences of adverse drug reactions such as urinary tract infection, electrocardiographic abnormality and blood glucose disorders of the two groups were collected. RESULTS: The total effective rate of the combination group was 90.48%(38/42), which was higher than that of the control group(73.17%, 30/41), with statistically significant difference(χ~2=4.196, P=0.041). The combination group had shorter duration of fever, duration of human immunoglobulin injection and length of stay than those of the control group(t=-3.924,-3.644 and-3.644, all P<0.01), and the hospital cost of the combination group was less than that of the control group(t=-11.871, P<0.01), with statistically significant differences. There were no statistical significance in differences in laboratory indexes between two groups before and after treatment(P>0.05). After 1 week of treatment, the Th1 cells proportion and the Th1/Th2 ratio of the combination group were higher than those of the control group, while the Th2 cells proportion and GDF-15 level of the combination group were lower than those of the control group(P<0.05); the difference values of Th1, Th2 and Th1/Th2 before and after treatment were higher in the combination group than those in the control group(P<0.05), with statistically significant difference. The incidences of total adverse drug reactions of the control group and the combination group were respectively 26.83%(11/41) and 21.43%(9/42), with no statistically significant difference(χ~2=0.331, P=0.565). CONCLUSIONS: The overall effect of glucocorticoids combination with human immunoglobulin in the treatment of children with KD is better than that of human immunoglobulin alone, which can improved Th2 cell activation, maintained Th1/Th2 balance and reduced GDF-15 level.更多还原