摘要
目的探讨川崎病患儿抗血栓治疗的效果及作用机制。方法选取2016年1月至2019年12月于河北省儿童医院就诊的82例川崎病患儿。根据是否合并冠状动脉病变(CAL)分为CAL组(30例)和非CAL组(52例);根据是否合并肝功能异常分为肝损伤组(35例)和非肝损伤组(47例);根据CAL分级及不同治疗方案,分为阿司匹林组(49例)、双嘧达莫组(17例)和阿司匹林联合华法林组(16例);根据是否进行华法林基因检测,将启动华法林抗凝治疗的患儿分为华法林个体化治疗组(8例)与常规治疗组(8例)。所有患儿检测血栓弹力图指标,探讨凝血状态与CAL的关系。分析华法林基因多态性检测在抗凝治疗中的价值。结果CAL组凝血反应时间(R值)低于非CAL组,血凝块最大振幅高于非CAL组[(3.6±1.1)min比(4.3±1.3)min、(71±9)mm比(59±10)mm],肝损伤组R值高于非肝损伤组,差异均有统计学意义(均P<0.05)。阿司匹林组有效率明显高于双嘧达莫组[75.5%(37/49)比47.0%(8/17)](P<0.05),阿司匹林联合华法林组有效率为100%(16/16),与阿司匹林组比较差异有统计学意义(P=0.03)。华法林个体化治疗组国际标准化比值初次达标时间短于常规治疗组[(10.5±2.2)d比(15.8±2.9)d],差异有统计学意义(P<0.01);2组华法林起始剂量及稳定剂量比较差异均无统计学意义(均P>0.05)。结论川崎病合并CAL患儿存在高凝状态,阿司匹林联合华法林在川崎病患儿抗血小板治疗中效果显著。血栓弹力图及华法林基因检测可有效评估并指导川崎病患儿抗血栓效果。
Objective To investigate the effect and mechanism of antithrombotic therapy on Kawasaki disease(KD).Methods From January 2016 to December 2019,82 KD children admitted to Hebei Children’s Hospital were enrolled.According to whether complicated with coronary artery lesions(CAL),they were divided into CAL group(30 cases)and non-CAL group(52 cases);according to whether complicated with liver dysfunction,they were divided into liver injury group(35 cases)and non-liver injury group(47 cases);according to CAL grade and therapeutic regimens,they were divided into aspirin group(49 cases),dipyridamole group(17 cases)and aspirin combined with warfarin group(16 cases);according to whether underwent gene detection for warfarin,children treated with warfarin anticoagulant therapy were divided into individualized warfarin therapy group(8 cases)and conventional therapy group(8 cases).Thrombelastography indexes were detected in all children to investigate the relationship between coagulation state and CAL.The value of detection of gene polymorphism in anticoagulant therapy was analyzed.Results The coagulation reaction time(R value)in CAL group was lower than that in non-CAL group,the maximum amplitude of blood clot in CAL group was higher than that in non-CAL group[(3.6±1.1)min vs(4.3±1.3)min,(71±9)mm vs(59±10)mm],and R value in liver injury group was higher than that in non-liver injury group(all P<0.05).Effective rate in aspirin group was significantly higher than that in dipyridamole group[75.5%(37/49)vs 47.0%(8/17)](P<0.05).Effective rate in aspirin combined with warfarin group was 100%(16/16)and it was statistically significant difference to compare with aspirin group(P=0.03).The first time to reach the standard of international normalized ratio in individualized warfarin therapy group was shorter than that in conventional therapy group[(10.5±2.2)d vs(15.8±2.9)d](P<0.01),but there were no significant differences in initial and stable doses of warfarin between the two groups(both P>0.05).Conclusions Children with KD c
作者
王华
张英谦
李博
郝京霞
张会敏
陈敬师
齐焕军
曹亚丽
闫兆坤
Wang Hua;Zhang Yingqian;Li Bo;Hao Jingxia;Zhang Huimin;Chen Jingshi;Qi Huanjun;Cao Yali;Yan Zhaokun(Department of Cardiology,Hebei Childrens Hospital,Hebei Provincial Key Laboratory of Pediatric Cardiovascular Disease,Shijiazhuang 050000,China)
出处
《中国医药》
2021年第11期1640-1644,共5页
China Medicine
基金
河北省重点研发计划(18277708D)
河北省卫生健康委员会临床医学人才培养项目(冀卫办科教[2021]1号)。
关键词
川崎病
冠状动脉瘤
凝血功能
血栓弹力图
基因多态性
Kawasaki disease
Coronary aneurysm
Coagulation function
Thrombelastography
Gene polymorphism
