Objective. To evaluate the effect of treatment without aspirin in the acute phase of Kawasaki disease (KD) and to determine whether it is necessary to expose children to high- or medium-dose aspirin.Methods. A total of 162 patients who fulfilled the established criteria of acute KD between 1993 and 2003 were included in this retrospective study. All patients were treated with high-dose intravenous immunoglobulin (IVIG; 2 g/kg) as a single infusion without concomitant aspirin treatment. Low-dose aspirin (3–5 mg/kg per day) was subsequently prescribed when fever subsided. Patients who had defervescence within 3 days after the completion of IVIG treatment were classified as the IVIG-responsive group, and those whose fever persisted for 3 days were classified as the IVIG-nonresponsive group. The 162 patients were divided further into 2 groups: those who were treated with IVIG before illness day 5, and those who were treated after illness day 5. We compared the response rate of IVIG therapy, duration of fever, and incidence of coronary artery abnormalities (CAAs) between these groups.Results. A total of 153 patients were classified into the IVIG-responsive group, and 128 (83.66%) of them had defervescence within 24 hours after completion of IVIG therapy. Nine (5.56%) patients were classified into the IVIG nonresponsive group, and all received additional IVIG (2 g/kg) without aspirin. Six (66.67%) had defervescence within 3 days after additional therapy. Patients in the IVIG-nonresponsive group had a significantly higher incidence of CAAs than those in the IVIG-responsive group (25% vs 2.92%). In the group that was treated before illness day 5 ( n = 16), all patients had defervescence within 3 days after IVIG therapy and 13 (81.25%) had defervescence within 24 hours. In the group that was treated after illness day 5 ( n = 146), 137 (93.84%) patients had defervescence within 3 days and 115 (78.77%) had defervescence within 24 hours. One (6.67%) patient in the group that was treated before illness day 5 got a new onset of CAAs, as did 5 (3.85%) in the group that was treated after illness day 5. There was no statistically significant difference in the response rate of IVIG therapy, duration of fever, and incidence of CAAs between these 2 groups.Conclusion. The results of our study indicate that the treatment without aspirin in acute stage of KD had no effect on the response rate of IVIG therapy, duration of fever, or incidence of CAAs when children were treated with high-dose (2 g/kg) IVIG as a single infusion, despite treatment before or after day 5 of illness. We conclude that it seems unnecessary to expose children to high- or medium-dose aspirin therapy in acute KD when the available data show no appreciable benefit in preventing the failure of IVIG therapy, formation of CAAs, or shortening the duration of fever.
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机译：目的。为了评估川崎病（KD）急性期不使用阿司匹林的治疗效果并确定是否有必要使儿童接触大剂量或中等剂量的阿司匹林。这项回顾性研究纳入了1993年至2003年间符合急性KD既定标准的162例患者。所有患者均接受了大剂量静脉注射免疫球蛋白（IVIG; 2 g / kg）的单次输注，未伴有阿司匹林治疗。发烧平息后，随后开了小剂量阿司匹林（每天3-5 mg / kg）的处方。 IVIG治疗结束后3天内退热的患者被归为IVIG应答组，持续发烧超过3天的患者被归为IVIG无应答组。将162例患者进一步分为2组：在疾病第5天之前接受过IVIG治疗的患者和在疾病第5天之后进行过治疗的患者。我们比较了IVIG治疗的反应率，发热持续时间和冠状动脉异常发生率这些组之间的（CAA）结果。共有153例患者被归为IVIG应答组，其中128例（83.66％）在完成IVIG治疗后24小时内出现了退热。 9例（5.56％）患者被分类为IVIG无反应组，所有患者均接受了额外的IVIG（2 g / kg），不含阿司匹林。补充治疗后3天内，有6名（66.67％）出现了退热。 IVIG无反应组的患者CAA发生率明显高于IVIG反应组（25％比2.92％）。在患病第5天（n = 16）之前接受治疗的组中，所有患者均在IVIG治疗后3天内退热，而13例（81.25％）在24小时内退热。在患病第5天后接受治疗的组中（n = 146），有137名患者（93.84％）在3天内退热，而115名患者（78.77％）在24小时内退热。在疾病第5天之前接受治疗的一组患者（6.67％）发生了新的CAA，在疾病第5天之后接受治疗的一组5（3.85％）发生了新的CAA。反应无统计学差异两组之间的IVIG治疗率，发烧持续时间和CAA发生率。我们的研究结果表明，在接受大剂量（2 g / kg）IVIG治疗的儿童中，在KD急性期不使用阿司匹林的治疗对IVIG治疗的反应率，发烧持续时间或CAA的发生率没有影响。尽管在疾病的第5天之前或之后进行了治疗，但仍为单次输注。我们得出的结论是，当现有数据显示在预防IVIG治疗失败，CAA形成或缩短发烧时间方面无明显益处时，似乎无需在急性KD中使儿童接受大剂量或中剂量阿司匹林治疗。
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