Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
권호 표지

Comparative study of therapeutic effects according to duration of medium-dose aspirin therapy at the acute stage of Kawasaki disease

가와사끼병의 급성기 중용량 aspirin 투여 기간에 따른 치료 효과 비교 연구

  • Lee, Jung Hwa (Department of Pediatrics, School of Medicine, Konkuk University) ;
  • Lee, So Hee (Department of Pediatrics, School of Medicine, Konkuk University) ;
  • Lee, Sang Taek (Department of Pediatrics, School of Medicine, Konkuk University) ;
  • Park, Yong Hyun (Department of Nursing, Chungju Hospital, Konkuk University) ;
  • Hong, Seong Jin (Department of Pediatrics, School of Medicine, Konkuk University)
  • 이정화 (건국대학교 의학전문대학원 소아과학교실) ;
  • 이소희 (건국대학교 의학전문대학원 소아과학교실) ;
  • 이상택 (건국대학교 의학전문대학원 소아과학교실) ;
  • 박용현 (건국대학교 충주병원 간호과) ;
  • 홍성진 (건국대학교 의학전문대학원 소아과학교실)
  • Received : 2006.03.07
  • Accepted : 2006.05.11
  • Published : 2006.07.15
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose : This study was performed to compare the therapeutic effects according to duration of medium-dose aspirin(50-60 mg/kg/day) therapy at the acute stage of Kawasaki disease(KD). Methods : Total 87 patients with KD were enrolled in this study. We performed retrospective analysis of clinical characteristics and echocardiographic findings based on medical records. Patient were randomly divided into 2 groups according to the duration of aspirin therapy at the acute stage of KD. Long-term group(LG, n=55) was administered medium-dose aspirin for 2 weeks after diagnosis of KD, and short-term group(SG, n=32) for 48 hours after intravenous immunoglobulin(IVIG) administration. The parameters of therapeutic effects were duration of fever after IVIG administration, incidence of unresponsive patients to single administration of IVIG, and development of transient dilatation or aneurysm of coronary arteries. Results : There was no significant difference in the duration of fever after IVIG between the both group(LG $1.7{\pm}1.1$ days, SG $1.8{\pm}1.1$ days; P=0.588). The incidences of unresponsive patient to the single administration of IVIG were 5.5 percent, 6.3 percent in the each group. Transient dilatation of coronary arteries occurred at 18.2 percent(10/55) in the LG, and 15.6 percent(5/32) in the SG(P=0.761). Prevalence of coronary aneurysm after subacute stage were 7.3 percent(4/55) in the LG, and 9.4 percent(3/32) in the SG(P=0.728). Conclusion : There was no significant difference in the therapeutic effects between long-term(2 weeks) and short-term(48 hours) administration of medium-dose aspirin at the acute stage of KD.

목 적 : 가와사끼병의 급성기 치료에서 중용량 aspirin(50-60 mg/kg/일)의 사용 기간의 차이에 따른 치료 효과를 비교하고자 연구를 하였다. 방 법 : 총 87명의 환아를 무작위로 두 군으로 나누어 한 군은 급성기동안 중용량 aspirin을 IVIG 투여 후 2주간 투여하였고(장기 투여군), 다른 군은 IVIG 투여 후 48시간 동안 투여하였다(단기 투여군). 치료 효과의 비교는 두 군간의 IVIG 투여 후 발열 기간, 1회 IVIG 투여에 대한 무반응 환자, 그리고 관상동맥 합병증 발생 여부 등을 의무 기록을 중심으로 후향적으로 조사하였다. 결 과 : IVIG 투여 후 발열 지속 기간을 보면 장기 투여군에서는 $1.7{\pm}1.1$일이었고 단기 투여군에서는 $1.8{\pm}1.1$일로 양 군사이의 의미 있는 차이는 없었다(P=0.588). IVIG 1회 투여에 반응하지 않은 무반응 환아는 장기 투여군에서는 5.5%, 단기 투여군에서는 6.3%의 발생률을 보였다(P=0.878). 관상동맥 합병증 발생 정도를 분석해보면 관상동맥의 일시적인 확장은 장기 투여군에서는 10명(18.1%)에서 관찰되었고 단기 투여군에서는 5명(15.6%)에서 관찰되었으며(P=0.761), 관상동맥류 발생률은 장기투여군에서는 4명(7.3%)이었고 단기 투여군에서는 3명(9.4%)으로 나타나서(P=0.728) 양 군 사이의 의미 있는 차이는 없었다. 결 론 : 가와사끼병의 급성기 중용량 aspirin의 투여 기간을 2주에서 IVIG 투여 후 48시간으로 단축하여도 발열 기간 및 관상동맥 합병증 발생률 등 치료 효과는 동일하게 나타났다.

Keywords

References

  1. Shulman ST, Rowley SH. Advances in Kawasaki disease. Eur J Pediatr 2004;163:285-91 https://doi.org/10.1007/s00431-004-1431-z
  2. Newburger JW, Takahashi M, Gerber MA, Gewitz MH, Tani LY, Burns JC, et al. Diagnosis, treatment, and longterm management of Kawasaki disease : A statement for health professionals from the committee on rheumatic fever, endocarditis and Kawasaki disease, Council on cardiovascular disease in the young, American Heart Association. Circulation 2004;110:2747-71 https://doi.org/10.1161/01.CIR.0000145143.19711.78
  3. Kusakawa S, Tatara K. Efficacies and risks of aspirin in the treatment of Kawasaki disease. Prog Clin Biol Resear 1987;250:401-13
  4. Harada K. Intravenous gammaglobulin treatment in Kawasaki disease. Acta Paediatr Jpn 1991;33:805-10 https://doi.org/10.1111/j.1442-200X.1991.tb02612.x
  5. Research Committee on Kawasaki disease. Report of subcommittee on standardization of diagnostic criteria and reporting of coronary artery lesions in Kawasaki disease. Tokyo, Japan. Ministry of Health and Welfare. 1984
  6. Kato H, Sugimura T, Akagi T, Sato N, Hashino K, Maeno Y Kazue T, et al. Long-term consequences of Kawasaki disease. A 10- to 21-year follow-up study of 594 patients. Circulation 1996;94:1379-85 https://doi.org/10.1161/01.CIR.94.6.1379
  7. Jacobs JC. Successful treatment of Kawasaki disease with high dose aspirin. Pediatr Res 1978;12:494
  8. Koren G, Rose V, Lavi S, Rowe R. Probable efficacy of high-dose salicylates in reducing coronary involvement in Kawasaki disease. JAMA 1985;254:767-9 https://doi.org/10.1001/jama.254.6.767
  9. Kato H, Koike S, Yokoyama T. Kawasaki disease : effect of treatment on coronary artery involvement. Pediatrics 1979; 63:175-9
  10. Ichida F, Fatica NS, Engle MA, O'Loughlin JE, Klein AA, Snyder MS, et al. Coronary artery involvement in Kawasaki syndrome in Manhattan, New York : risk factors and role of aspirin. Pediatrics 1987;80:828-35
  11. Koren G, Schaffer F, Silverman E. Determinant of low serum concentrations of salicylate in patient with Kawasaki disease. J Pediatr 1988;112:663-7 https://doi.org/10.1016/S0022-3476(88)80194-X
  12. Akagi T, Kato H, Inoue O, Sato N. Salicylate treatment in Kawasaki disease : High dose or low dose? Eur J Pediatr 1991;150:642-6 https://doi.org/10.1007/BF02072625
  13. Matsubara T, Mason W, Kashini IA. Gastrointestinal hemorrhage complicating aspirin therapy in acute Kawasaki disease. J Pediatr 1996;128:701-3 https://doi.org/10.1016/S0022-3476(96)80140-5
  14. Lee JH, Hung HY, Huang FY. Kawasaki disease and Reye syndrome : report of one case. Acta Paed Sin 1992;33:67-71
  15. Mulberg AE, Verhave M. Identification and treatment of nonsteroidal anti-inflammatory drug-induced gastroduodenal injury in children. Am J Dis Child 1993;147:1280-1
  16. Hanley SP, Bevan J, Cockbill SR, Heptinstall S. Differential inhibition by low-dose aspirin of human venous prostacyclin synthesis and platelet thromboxane synthesis. Lancet 1981;2:969-71
  17. Furusho K, Sato K, Soeda T, Matsumoto H, Hirota T, Kawada S. High-dose intraveous gammaglobulin for Kawasaki disease. Lancet 1983;10:1359
  18. Melish ME. Comparison of low-dose aspirin vs. high dose aspirin as an adjunct to intravenous gamma globulin in the treatment of Kawasaki syndrome. Pediatr Res 1992;31:170A https://doi.org/10.1203/00006450-199202000-00016
  19. Durongpisitkul K, Gururaj VJ, Park JM, Martin CF. The prevention of coronary artery aneurysm in Kawasaki disease : a meta-analysis on the efficacy of aspirin and immunoglobulin treatment. Pediatrics 1995;96:1057-61
  20. Terai M, Shulman ST. Prevalence of coronary artery abnormalities in Kawasaki disease is highly dependent on gamma globulin but independent of salicylate dose. J Pediatr 1997;131:888-93 https://doi.org/10.1016/S0022-3476(97)70038-6
  21. Moran AM, Newburger JW, Sanders SP, Parness IA, Spevak PJ, Burns JC, et al. Abnormal myocardial mechanics in Kawasaki disease : rapid response to gamma-globulin. Am Heart J 2000;139:217-23
  22. Saulsbury FT. Comparison of high-dose and low-dose aspirin plus intravenous immunoglobulin in the treatment of Kawasaki syndrome. Clin Pediatr 2002;41:597-601 https://doi.org/10.1177/000992280204100807
  23. Hsieh KS, Weng KP, Lin CC, Huang TC, Lee CL, Haung SM. Treatment of acute Kawasaki disease : Aspirin's role in the febrile stage revisited. Pediatrics 2004;114:689-93 https://doi.org/10.1542/peds.2004-1037