Introduction to the latest progress in the treatment of Kawasaki disease

Kawasaki disease is a very common disease in life. If not treated in time, it will cause many complications to the patient and be detrimental to the recovery of the disease. Therefore, timely treatment can help patients recover as soon as possible. Below is an introduction to the new progress in the treatment of Kawasaki disease. I hope it will be helpful to everyone.

1. Acute Phase Treatment

1. Recent studies on immunoglobulin have confirmed that early intravenous infusion of immunoglobulin plus oral aspirin can reduce the incidence of Kawasaki disease coronary artery aneurysm. It must be emphasized that medication should be used within 10 days after onset. The dosage is daily intravenous infusion of immunoglobulin 400mg/kg, infused over 2 to 4 hours, for 4 consecutive days; at the same time, oral aspirin 50-100mg/kg·d, divided into 3 to 4 times, for 4 consecutive days, and then increased to 5mg/kg·d, taken all at once.

2. Aspirin. Early oral aspirin can control the acute inflammatory process and reduce coronary artery lesions, but no controlled studies have shown that aspirin treatment can reduce the incidence of coronary artery aneurysms. The dosage is 30-100 MG·KG per day, divided into 3-4 times. Japanese doctors tend to use small doses, based on the fact that those who take large doses during the acute phase of Kawasaki disease believe that acute patients have reduced aspirin absorption and increased clearance, and only large doses can achieve anti-inflammatory effects. Take it for 14 days, and reduce it to 3-5 MG/KG per day after the fever subsides, once a day, and the anti-platelet aggregation effect is fully achieved.

3. Corticosteroids: It has always been believed that adrenal cortex hormones have strong anti-inflammatory effects and can relieve symptoms. However, it was later found that corticosteroids are prone to thrombosis, hinder the repair of coronary artery lesions, and promote aneurysm formation. Therefore, it is not appropriate to use corticosteroids such as prednisone alone for treatment. Unless there is a complication of severe myocarditis or persistent high fever in severe cases, prednisone and aspirin can be used in combination for treatment. In order to control the early inflammatory response of Kawasaki disease, corticosteroids are generally not used alone.

2. Treatment during the recovery period

1. Anticoagulant therapy: For patients in the recovery stage, take aspirin 3-5 MG/KG daily, once a day, until the erythrocyte sedimentation rate and platelet count return to normal. If there is no coronary artery abnormality, the drug is generally discontinued 6-8 weeks after onset. Echocardiograms should be repeated 6 months and 1 year thereafter. For patients with chronic coronary artery disease, long-term anticoagulant drugs and close follow-up are required. Patients with small single coronary artery aneurysms should take aspirin 3-5 MG/KG·D for a long time until the aneurysm subsides.

These patients should limit their activities and not participate in sports. Check their heart condition every 3 to 6 months. If there are signs of myocardial ischemia or a positive exercise test, coronary angiography should be performed to understand the progression of stenosis. Patients with occlusion of one or more major coronary arteries should receive long-term anticoagulant therapy, repeated heart examinations, including myocardial scanning, exercise testing, coronary angiography, etc., and consider surgical treatment.

2. Thrombolytic therapy: Patients with myocardial infarction and thrombosis are treated with intravenous or percutaneous catheter puncture intracoronary artery administration to promote coronary artery recanalization and myocardial reperfusion. Intravenous thrombolysis is performed within 1 hour with urokinase 20000U/KG, followed by 3000-4000U/KG per hour. Intracoronary artery administration is performed within 1 hour with urokinase 1000U/KG. Streptokinase can also be used, intravenous thrombolysis is performed within 1 hour with streptokinase 10000U/KG, and it can be used again half an hour later. The above drugs dissolve fibrin quickly, with good effects and no adverse reactions.

We have introduced in detail the treatment methods for Kawasaki disease at each stage. We must master its common symptoms and conduct careful examinations in life. If we find that the child has symptoms such as fever, we must take the child for treatment immediately. In addition, everyone should pay attention to preventing some complications from occurring in the child.