A Comparative Study of Therapeutic Effect of Aspirin Alone and Intravenous Gammaglobulin Plus Aspirin in Kawasaki Disease

Kawasaki병에 있어 아스피린 단독 투여시와 정맥내 감마 글로불린 병용시에 치료효과에 대한 연구

We compared the efficacy of each modality of treatment group in reducing the frequency of coronary artery abnormalities and changes of clinical courses in children with kawasaki disease in the children of 81 cases who were admitted in pediatric department of Yeungnam University Hospital from September 1985 to August 1990, Group A(37 cases)-aspirin alone, Group B(44 cases)-intravenous gammaglobulin(400mmg/kg/day) for 5 consecutive days, plus aspirin. We studied the frequency of echocardiographic abnormalities, the duration of fever, and changes in the total white blood cell counts, platelet counts, ESR and CRP value at 1, 2 and 3 weeks of the illness and compared the results between the two groups. The results were as follows, 1) There as no significant intergroup difference in age and sex ratio. 2) The duration of the febrile period after the initiation of the therapy was significant shorter in group B($2.5{\pm}1.2$ days) than in group A:($5.2{\pm}3.5$ days)(p<0.01). 3) No significant difference was noticed in the WBC and platelet counts in two groups as measured at admission day, 1 and 2 weeks of the illness. However, at 3weeks of illness significant difference was noted. 4) The CRP values measured at 1, 2 and 3 weeks after treatment were significantly lower in group B($2.42{\pm}1.8$, $2.00{\pm}1.2$, $1.16{\pm}1.0$) than in group A($7.22{\pm}5.3$, $5.25{\pm}3.9$, $1.85{\pm}1.2$) respectively(p<0.01). 5) In 2D- Echocardiogram, coronary artery dilataton was more frequent in Group A than in Group B at 6month of illness(p<0.01). In conclusion, intravenous gammaglobulin therapy was effective in the shortening of the duration of fever and in the antiinflammatory action and somewhat effective in prevention of coronary artery aneurysm.

1985년 9월부터 1990년 8월까지 만 5년간 영남대학교 의과대학부속병원 소아과에 입원하여 가와사끼병으로 진단된 환아를 대상으로 아스피린 단독 치료한 A군과 아스피린과 정맥내 면역글로불린을 병용 치료한 B군으로 나누어 발열기간, 혈액검사소견 및 심초음파 검사소견을 비교 분석하여 다음과 같은 결론을 얻었다. 1) 발열기간은 A군과 B군에서 치료 시작전까지의 기간에서는 별 차이가 없었으나, 치료 시작후 발열기간은 B군이 $2.5{\pm}1.2$일로서 A군 $5.2{\pm}3.5$ 일보다 의미 있게 짧았다(p<0.01). 2) 백혈구수와 혈소판수는 입원시는 두 군간의 차이가 없었으나 입원 3주째 B군에서는 정상으로 회복되고 A군보다 의의 있는 감소를 보였으며(p<0.01), CRP는 A군에서는 서서히 회복되어 입원 3주째 정상화로 되었으나 B군에서는 입원 1주째 부터 유의할 만한 감소를 나타내었다(p<0.01). 3) 심초음파 검사상 입원시 관상동맥 확장은 A군은 24%, B군은 27%로 별 차이가 없었으나 6개월 째는 A군(11%)보다 B군(7%)의 발생빈도가 다소 감소 되었으며, 약간의 유의성이 있었다(p<0.05). 결론적으로 가와사끼병에서 면역글로불린과 아스피린의 병용사용이 급성 염증 치료효과 및 관상동맥류 발생억제에 도움이 되었다.