糖皮质激素联合人免疫球蛋白治疗川崎病患儿的 疗效及对外周血Th1/Th2 和GDF-15 水平的影响.

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 (χ² = 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 (χ² = 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. [ABSTRACT FROM AUTHOR]