Follow-up And Therapy Study Of 123 Cases Of Kawasaki Disease

Objectives The aim of this study was to provide clinical evidence for the management and prognosis estimating of Kawasaki disease (KD).Methods Totally 123 patients with KD were hospitalized from Jun. 2002 to Dec. 2003. The remedy [Intravenous gamma globulin (IVGG) 1 g/(kg·d) injection one to two days plus acetylsalicylic acid (ASA) reducing gradually after defervescence] and cardiac compliance within 2 years were analyzed.Results (1) IVGG treatment on day 4 or earlier and serum albumin were independently associated with resistance to high-dose IVGG. All the 12 cases refractory to initial IVGG were sensitive to additional IVGG. (2) 51.2%(22/43) of mild coronary artery dilations (<4 mm) regressed within 6 months, 81.4%(35/43) within 1 year, and 97.7%(42/43) regressed within 2 years. 5 of the 10 coronary artery aneurysms (CAA) remained over 2 years, including 2 giant CAAs (>8 mm). There is no myocardial infarction or death. (3) Among the 6 recurrent cases, one had new coronary artery lesions; three had expanding coronary artery lesions. Among the 3 cases that recurred within 2 months, IVGG and ASA had not been used in one case, and ASA was reduced to low dose just 3 days after defervescence in 2 cases. The cases that recurred within 2 months were more likely to occur in which ASA was reduced to low dose just 3 days after defervescence than those in which gradually. (4) 3 coronary artery lesions exacerbated between 2 to 6 months, and they all had acute upper respiratory infection before that. (5) Low dose aspirin was used at the convalescent- to chronic-stage of KD, when there was no obvious side-effect. (6) Erythrocyte sedimentation rates (ESR) of 118 patients were above 10mm/h. They all decreased to normal (≤10mm/h) in 12 to 90 days , and 71 of them (57.7%) decreased in 20 to 40 days.Conclusions (1) Patients should be treated with IVGG 1 g/(kg·d) as early as possible when diagnosed as KD. Those refractory to initial IVGG should be treated with additional IVGG. It is of much help to a decreased prevalence of CAA. (2) 81.4%(35/43) of mild coronary artery dilations regressed within 1 year, and 50% of CAA regressed within 2 years. (3) Gradually reducing ASA may lead to a lower recurrent rate within the initial 2 months. (4) After the convalescent stage of KD, respiratory infection might be an inducement of expanding coronary artery lesions.