【作者】 杨敏；

【导师】 钟家蓉；

【作者基本信息】 重庆医科大学 ， 儿科学， 2014， 硕士

【摘要】 目的：探讨川崎病（Kawasaki disease，KD）患儿使用氯吡格雷(Clopidogrel)联合阿司匹林抑制血小板聚集的临床疗效及安全性。方法：选取重庆医科大学附属儿童医院收治的60例川崎病患儿随机分为两组，热退48-72h后A组予以氯吡格雷及阿司匹林联合抗血小板聚集治疗30例，B组给予以阿司匹林及双嘧达莫联合抗血小板聚集治疗30例。观察两组患儿使用抗血小板药物治疗前及治疗3个月后白细胞计数（WBC）、中性粒细胞比例（N）、血小板计数（PLT），以及治疗3个月、6个月、1年后心脏彩超（冠状动脉危险分级和冠状动脉血栓变化情况），并评估临床疗效，记录可能的药物不良反应。结果：（1）两组抗血小板治疗后与抗血小板治疗前比较，WBC、N、PLT均明显降低(P <0.05)。抗血小板治疗前及治疗后两组WBC、N、PLT分别比较，差异均无统计学意义（P>0.05）。（2）比较两组患儿抗血小板治疗3个月、6个月、1年后冠状动脉危险程度，差异均无统计学意义（P>0.05）。（3）从冠状动脉血栓变化方面判断疗效，抗血小板治疗3个月后A组有效率（76.92%）稍高于B组有效率（62.50%），抗血小板治疗6个月后A组有效率（91.67%）较B组有效率（71.43%）略高，抗血小板治疗1年后A组有效率（85.71%）稍高于B组有效率（75.00%），但差异均无统计学意义（P>0.05）。（4）氯吡咯雷联合阿司匹林组有2例鼻衄、1例双下肢瘀斑瘀点。阿司匹林联合双嘧达莫组有1例呕吐，3例鼻衄及皮肤瘀斑瘀点，1例全身散在红色斑丘疹。结论:在抗血小板聚集、预防川崎病患儿冠状动脉血栓形成方面，氯吡格雷联合阿司匹林抗血小板治疗与阿司匹林联合双嘧达莫抗血小板治疗疗效相当，不良反应未增加，安全性高。更多还原

【Abstract】 Objective To study the effciency and safety of antiplatelet therapy withclopidogrel and aspirin in Kawasaki disease(KD).Methods Selected60children with KD from the children’s hospitalaffiliated Chongqing Medical University and randomly divided into twogroups,one accepted clopidogrel and aspirin with30children as group A,the other30children received aspirin and dipyridamole as groupB.Observed the white blood count (WBC),the neutrophile percentage(N),the platelet count (PLT) in both groups before and after3-monthantiplatelet therapy,and cardiac color ultrasonography (coronary arteryrisk level and the change of coronary thrombosis)after3-month,6-monthand1year antiplatelet therapy,and estimated the clinical curative effect,recorded adverse drug reactions.Results (1)WBC,N,PLT were significantly reduced after treatment（P<0.05）in both groups,and compared WBC,N,PLT in the two groupsbefore and after3-month antiplatelet therapy,the differences were not statistically significant(P>0.05).(2)Compared the coronary arterydangerous degree in the two groups after3-month,6-month and1-yeartreatment, the differences were not statistically significant(P>0.05).(3)Theeffective rate was evaluated through change of coronary arterythrombosis,group A (76.92%)result in slightly better outcome than groupB(62.50%) after3-month antiplatelet treatment，group A (91.67%)result inslightly better outcome than group B(71.43%) after6-month antiplatelettreatment,group A (85.71%)result in slightly better outcome than groupB(75.00%) after1-year antiplatelet treatment,but the differences were notsignificant(P>0.05).(4) There were2cases with epistaxis,1case withecchymosis petechiae in double lower extremities among the groupcombined with clopidogrel and aspirin,and The group of dipyridamolecombinated with aspirin had1cases vomiting,3cases with epistaxis,bloody stool, skin ecchymosis petechiae,1case with systemic scattered redmaculopapule.Conclusion To prevent the platelet aggregation and coronarythrombosis in children with KD, combined treatment of KD withclopidogrel and aspirin was as good as traditional treatment with aspirinand dipyridamole, and adverse reactions did not increase.更多还原