| The Optimal Dosages of Gammaglobulin and Aspirin in Treating Kawasaki Disease |
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Seung Baik Han, Jong Woon Choi, Soon Ki Kim, Sei Woo Chung, Jeung Gyu Kim, Byong Kwan Son |
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Department of Pediatrics, Inha University Hospital, Seongnam, Korea |
| 가와사키병의 치료에서 감마글로불린 및 아스피린의 적정 용량에 관한 연구 |
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한승백, 최종운, 김순기, 정세우, 김정규, 손병관 |
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인하대학교 의과대학 소아과학교실 |
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| Abstract |
Purpose
: There are some disagreements about the optimal dosages of intravenous
gammaglobulin(IVGG) and oral aspirin(ASA) in the treatment of Kawasaki disease. So
authors performed a prospective clinical study to evaluate the efficacy of IVGG 1g/kg
plus ASA 50mg/kg/day.
Methods
: We treated 29 patients who were admitted to Inha University Hospital from
June 1993 through May 1994 with IVGG 1g/kg plus ASA 50mg/kg/d. We compared the
outcomes of above patients with those of two other groups of patients, group A and B
inauthors’previous study. Group A(20patients) had been treated with IVGG 2g/kg plus
ASA 50mg/kg/d and group B(19 patients) with IVGG 2g/kg plus ASA 100mg/kg/d. The
outcomes had been similar in group A and B, which was published on this journal in
1995 (vol.38:378-385).
Results
: 1) Twenty five patients(86.2%; group C) were given only one dose of IVGG 1g/kg, and remaining 4 patients(13.8%; group D) were given two doses of IVGG 1g/kg because of persistent high fever.
2) The age and sex distributions, durations of fever before treatment, and durations of ASA therapy in group C were not significantly different from those in group A and B(p>0.05).
3) Laboratory findings on admission in group C were not significantly different from
those in group A and B, except that the mean ESR was lower in group C than in group
A and B (35.1±19.8 vs 55.5±5.95 & 50.2±11.4mm/hr; p<0.01, respectively).
4) The durations of fever after treatment in group C were not significantly different
from those in group A and B (1.32±1.07 vs 2.65±3.28 & 1.74±1.52 days; p>0.05,
respectively).
5) In group C, the mean hemoglobin concentration at the 3rd week of illness was
higher than in group A (11.1±0.98 vs 10.1±1.24g/dl; p<0.05), the mean platelet countat the 2nd week of illness was lower than in group A (59.4±18.0×104 vs 73.6±19.0×104/μl; p<0.05), and the mean ESRs at the 2nd and 3rd week of illness were lower than in group A (43.3±14.7 vs 54.0±9.16,31.9±19.0 vs 47.7±13.0mm/hr; p<0.05, respectively). Other follow-up laboratory findings in group C were not significantly different from those in group A and B.
6) Echocardiography was done 2 and 4 weeks after onset of illness. Coronary arterial
dilation was observed in four(4/25; 16%) and two(2/23; 8.7%) patients respectively in
group C, and the proportions were not significantly different from those in group A(40% & 25%) and B(31.6% & 10.5%) (p>0.05, respectively). In follow-up examinations,
coronary aneurysm was observed in only one(1/23;4.3%) in group C, which was similar
to group A(1/18;5.5%) and B(1/19;5.2%)(p>0.05, respectively). Giant aneurysm was not
observed in any patients.
7) Four patients(group D) were given one more dose of IVGG 1g/kg because high
fever persisted 48 hours after injection of the first dose of IVGG. Afterthen fever
subsided within 1 to 7 days. Echocardiography revealed mild coronary arterial dilation in two patients initially, but follow-up examinations revealed no coronary aneurysm.
Conclusion
: The medium-dose combined regimen with IVGG 1g/kg plus ASA
50mg/kg/d seems to be more cost-effective than the high-dose regimen with IVGG
2g/kg plus ASA 50-100mg/kg/d. If high fever persists 48 hours or more after the first
dose of IVGG 1g/kg, it is desirable to give one more dose of IVGG 1g/kg. |
| Key Words:
Kawasaki disease, Intravenous gammaglobulin, Aspirin, Dose |
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