糖皮质激素在川崎病治疗中的儿科专家共识

doi:10.7499/j.issn.1008-8830.2112033

Abstract
Figure/Table
References(56)
Related Citation (15)
Read Tracking
Download Tracking

Download: PDF (648 KB) HTML
Export: BibTeX | EndNote (RIS) Supporting Info

Abstract Kawasaki disease (KD) is one of the common acquired heart diseases in under-5-year-old children and is an acute self-limiting vasculitis. After nearly 60 years of research, intravenous immunoglobulin combined with oral aspirin has become the first-line treatment for preventing coronary artery aneurysm in the acute stage of KD. However, glucocorticoid (GC), infliximab, and other immunosuppressants are options for the treatment of KD patients with a high risk of coronary artery aneurysm, no response to intravenous immunoglobulin and a confirmed diagnosis of coronary artery aneurysm. At present, there are still controversies over the use of GC in the treatment of KD. With reference to the latest research findings of KD treatment in China and overseas, this consensus invited domestic pediatric experts to fully discuss and put forward recommendations on the indications, dosage, and usage of GC in the first-line and second-line treatment of KD.

	Service

	E-mail this article
	Add to my bookshelf
	Add to citation manager
	E-mail Alert
	RSS
	Articles by authors

Key words： Kawasaki disease Glucocorticoid Expert consensus Child

Received: 08 December 2021

Cite this article:

. Pediatric expert consensus on the application of glucocorticoids in Kawasaki disease[J]. CJCP, 2022, 24(3): 225-231.

URL:

http://www.zgddek.com/EN/10.7499/j.issn.1008-8830.2112033 OR http://www.zgddek.com/EN/Y2022/V24/I3/225

	Du ZD, Zhao D, Du JB, et al. Epidemiologic study on Kawasaki disease in Beijing from 2000 through 2004[J]. Pediatr Infect Dis J, 2007, 26(5): 449-451. PMID: 17468660. DOI: 10.1097/01.inf.0000261196.79223.18.
	2 Du ZD. Epidemiologic features of Kawasaki disease in China[C]. Yokohama: 12th International Kawasaki Disease Symposium, 2018.
	McCrindle BW, Rowley AH, Newburger JW, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a scientific statement for health professionals from the American Heart Association[J]. Circulation, 2017, 135(17): e927-e999. PMID: 28356445. DOI: 10.1161/CIR.0000000000000484.
	Yang TJ, Lin MT, Lu CY, et al. The prevention of coronary arterial abnormalities in Kawasaki disease: a meta-analysis of the corticosteroid effectiveness[J]. J Microbiol Immunol Infect, 2018, 51(3): 321-331. PMID: 28927685. DOI: 10.1016/j.jmii.2017.08.012.
	Kato H, Koike S, Yokoyama T. Kawasaki disease: effect of treatment on coronary artery involvement[J]. Pediatrics, 1979, 63(2): 175-179. PMID: 440805.
	陕西省川崎病诊疗中心, 陕西省儿童内科疾病临床医学研究中心, 陕西省人民医院儿童病院, 等. 静脉输注免疫球蛋白在儿童川崎病中应用的专家共识[J]. 中国当代儿科杂志, 2021, 23(9): 867-876. PMID: 34535199. PMCID: PMC8480171. DOI: 10.7499/j.issn.1008-8830.2107110.
	Chang LS, Kuo HC. The role of corticosteroids in the treatment of Kawasaki disease[J]. Expert Rev Anti Infect Ther, 2020, 18(2): 155-164. PMID: 31914832. DOI: 10.1080/14787210.2020.1713752.
	Wright DA, Newburger JW, Baker A, et al. Treatment of immune globulin-resistant Kawasaki disease with pulsed doses of corticosteroids[J]. J Pediatr, 1996, 128(1): 146-149. PMID: 8551407. DOI: 10.1016/s0022-3476(96)70447-x.
	9 甄立娜, 段晨初, 赵德运, 等. 激素在丙种球蛋白无反应性川崎病中治疗效果的研究[J]. 心肺血管病杂志, 2019, 38(8): 833-837. DOI: 10.3969/j.issn.1007-5062.2019.08.004.
	穆志龙, 焦富勇, 谢凯生. 《川崎病心血管后遗症的诊断和管理指南(JCS/JSCS2020)》解读[J]. 中国当代儿科杂志, 2021, 23(3): 213-220. PMID: 33691912. PMCID: PMC7969191. DOI: 10.7499/j.issn.1008-8830.2010134.
	11 李华斌, 罗菲菲, 蒋莉, 等. 糖皮质激素治疗降低川崎病患儿冠状动脉病变发生风险的Meta分析[J]. 重庆医学, 2015, 44(3): 356-358. DOI: 10.3969/j.issn.1671-8348.2015.03.023.
	Wooditch AC, Aronoff SC. Effect of initial corticosteroid therapy on coronary artery aneurysm formation in Kawasaki disease: a meta-analysis of 862 children[J]. Pediatrics, 2005, 116(4): 989-995. PMID: 16199713. DOI: 10.1542/peds.2005-0504.
	Marchesi A, Rigante D, Cimaz R, et al. Revised recommendations of the Italian Society of Pediatrics about the general management of Kawasaki disease[J]. Ital J Pediatr, 2021, 47(1): 16. PMID: 33494789. PMCID: PMC7830049. DOI: 10.1186/s13052-021-00962-4.
	de Graeff N, Groot N, Ozen S, et al. European consensus-based recommendations for the diagnosis and treatment of Kawasaki disease: the SHARE initiative[J]. Rheumatology (Oxford), 2019, 58(4): 672-682. PMID: 30535127. DOI: 10.1093/rheumatology/key344.
	15 郝胜. 儿童风湿性疾病相关巨噬细胞活化综合征诊断与治疗专家共识之五——川崎病篇[J]. 中国实用儿科杂志, 2020, 35(11): 841-845. DOI: 10.19538/j.ek2020110605.
	16 黄笛, 黄瑞秀, 郭晨煜, 等. 临床实践指南制定方法——证据分级与推荐强度[J]. 中国循证心血管医学杂志, 2018, 10(7): 769-776. DOI: 10.3969/j.issn.1674-4055.2018.07.01.
	17 BalshemH, HelfandaM, SchunemannHJ, 等. GRADE指南: Ⅲ. 证据质量分级[J]. 中国循证医学杂志, 2011, 11(4): 451-455. DOI: 10.3969/j.issn.1672-2531.2011.04.017.
	18 宁光, 马志中, 王卫庆, 等. 糖皮质激素类药物临床应用指导原则[J]. 中华内分泌代谢杂志, 2012, 28(2): 增录2a-1-增录2a-32.
	Furusho K, Kamiya T, Nakano H, et al. High-dose intravenous gammaglobulin for Kawasaki disease[J]. Lancet, 1984, 2(8411): 1055-1058. PMID: 6209513. DOI: 10.1016/s0140-6736(84)91504-6.
	20 糖皮质激素急诊应用共识专家组. 糖皮质激素急诊应用专家共识[J]. 中华急诊医学杂志, 2020, 29(6): 765-772. DOI: 10.3760/cma.j.issn.1671-0282.2020.06.005.
	Morishita KA, Goldman RD. Kawasaki disease recognition and treatment[J]. Can Fam Physician, 2020, 66(8): 577-579. PMID: 32817030. PMCID: PMC7430790.
	22 Shah R, Hirzallah H, Fares M, et al. Review of Kawasaki disease[J]. Marshall J Med, 2018, 4(1): Article 4. DOI: 10.18590/mjm.2018.vol4.iss1.4.
	Shin J, Lee H, Eun L. Verification of current risk scores for Kawasaki disease in Korean children[J]. J Korean Med Sci, 2017, 32(12): 1991-1996. PMID: 29115081. PMCID: PMC5680498. DOI: 10.3346/jkms.2017.32.12.1991.
	Wardle AJ, Connolly GM, Seager MJ, et al. Corticosteroids for the treatment of Kawasaki disease in children[J]. Cochrane Database Syst Rev, 2017, 1(1): CD011188. PMID: 28129459. PMCID: PMC6464937. DOI: 10.1002/14651858.CD011188.pub2.
	Yu JJ. Use of corticosteroids during acute phase of Kawasaki disease[J]. World J Clin Pediatr, 2015, 4(4): 135-142. PMID: 26566486. PMCID: PMC4637804. DOI: 10.5409/wjcp.v4.i4.135.
	Friedman KG, Jone PN. Update on the management of Kawasaki disease[J]. Pediatr Clin North Am, 2020, 67(5): 811-819. PMID: 32888683. DOI: 10.1016/j.pcl.2020.06.002.
	中华医学会儿科学分会儿童用药委员会, 中华医学会儿科学分会免疫学组, 《中华儿科杂志》编辑委员会. 糖皮质激素在儿童风湿病中应用专家共识(上)[J]. 中华儿科杂志, 2018, 56(3): 166-173. PMID: 29518825. DOI: 10.3760/cma.j.issn.0578-1310.2018.03.003.
	28 杨莹, 张静. 激素与静脉丙种球蛋白及其联合应用治疗静脉丙种球蛋白无反应川崎病的回顾性对照研究[J]. 中国循证儿科杂志, 2016, 11(4): 265-269. DOI: 10.3969/j.issn.1673-5501.2016.04.005.
	Miyata K, Kaneko T, Morikawa Y, et al. Efficacy and safety of intravenous immunoglobulin plus prednisolone therapy in patients with Kawasaki disease (post RAISE): a multicentre, prospective cohort study[J]. Lancet Child Adolesc Health, 2018, 2(12): 855-862. PMID: 30337183. DOI: 10.1016/S2352-4642(18)30293-1.
	李静, 王博龙, 冯瑞冰, 等. 糖皮质激素联合免疫球蛋白用于川崎病初始治疗有效性的Meta分析[J]. 中国当代儿科杂志, 2016, 18(6): 527-533. PMID: 27324542. PMCID: PMC7389076. DOI: 10.7499/j.issn.1008-8830.2016.06.012.
	Ae R, Abrams JY, Maddox RA, et al. Corticosteroids added to initial intravenous immunoglobulin treatment for the prevention of coronary artery abnormalities in high-risk patients with Kawasaki disease[J]. J Am Heart Assoc, 2020, 9(17): e015308. PMID: 32811256. PMCID: PMC7660775. DOI: 10.1161/JAHA.119.015308.
	Kobayashi T, Saji T, Otani T, et al. Efficacy of immunoglobulin plus prednisolone for prevention of coronary artery abnormalities in severe Kawasaki disease (RAISE study): a randomised, open-label, blinded-endpoints trial[J]. Lancet, 2012, 379(9826): 1613-1620. PMID: 22405251. DOI: 10.1016/S0140-6736(11)61930-2.
	Zhu BH, Lv HT, Sun L, et al. A meta-analysis on the effect of corticosteroid therapy in Kawasaki disease[J]. Eur J Pediatr, 2012, 171(3): 571-578. PMID: 22057683. PMCID: PMC3284666. DOI: 10.1007/s00431-011-1585-4.
	Fukazawa R, Kobayashi J, Ayusawa M, et al. JCS/JSCS 2020 guideline on diagnosis and management of cardiovascular sequelae in Kawasaki disease[J]. Circ J, 2020, 84(8): 1348-1407. PMID: 32641591. DOI: 10.1253/circj.CJ-19-1094.
	Patel RM, Shulman ST. Kawasaki disease: a comprehensive review of treatment options[J]. J Clin Pharm Ther, 2015, 40(6): 620-625. PMID: 26547265. DOI: 10.1111/jcpt.12334.
	Ogata S, Ogihara Y, Honda T, et al. Corticosteroid pulse combination therapy for refractory Kawasaki disease: a randomized trial[J]. Pediatrics, 2012, 129(1): e17-e23. PMID: 22144699. DOI: 10.1542/peds.2011-0148.
	Gamez-Gonzalez LB, Moribe-Quintero I, Cisneros-Castolo M, et al. Kawasaki disease shock syndrome: unique and severe subtype of Kawasaki disease[J]. Pediatr Int, 2018, 60(9): 781-790. PMID: 29888440. DOI: 10.1111/ped.13614.
	Newburger JW, Takahashi M, Gerber MA, et al. Diagnosis, treatment, and long-term 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[J]. Circulation, 2004, 110(17): 2747-2771. PMID: 15505111. DOI: 10.1161/01.CIR.0000145143.19711.78.
	Rassas A, Guizani R, Werdani A, et al. Kawasaki disease shock syndrome complicated by coronary aneurysms: a case report[J]. Pan Afr Med J, 2021, 38: 52. PMID: 33854681. PMCID: PMC8017355. DOI: 10.11604/pamj.2021.38.52.27599.
	蒋道菊, 黄萍, 张丽, 等. 川崎病休克综合征的研究进展[J]. 中华儿科杂志, 2016, 54(12): 961-963. PMID: 27938603. DOI: 10.3760/cma.j.issn.0578-1310.2016.12.020.
	akan M, Gemici H, Aktay-Ayaz N, et al. Kawasaki disease shock syndrome: a rare and severe complication of Kawasaki disease[J]. Turk J Pediatr, 2016, 58(4): 415-418. PMID: 28276216. DOI: 10.24953/turkjped.2016.04.012.
	Ma L, Zhang YY, Yu HG. Clinical manifestations of Kawasaki disease shock syndrome[J]. Clin Pediatr (Phila), 2018, 57(4): 428-435. PMID: 28905639. DOI: 10.1177/0009922817729483.
	García-Pavón S, Yamazaki-Nakashimada MA, Báez M, et al. Kawasaki disease complicated with macrophage activation syndrome: a systematic review[J]. J Pediatr Hematol Oncol, 2017, 39(6): 445-451. PMID: 28562511. DOI: 10.1097/MPH.0000000000000872.
	44 周利兵. 川崎病并发巨噬细胞活化综合征的研究进展[J]. 临床儿科杂志, 2018, 36(10): 796-800. DOI: 10.3969/j.issn.1000-3606.2018.10.017.
	Grom AA, Horne A, De Benedetti F. Macrophage activation syndrome in the era of biologic therapy[J]. Nat Rev Rheumatol, 2016, 12(5): 259-268. PMID: 27009539. PMCID: PMC5851441. DOI: 10.1038/nrrheum.2015.179.
	Han SB, Lee SY. Macrophage activation syndrome in children with Kawasaki disease: diagnostic and therapeutic approaches[J]. World J Pediatr, 2020, 16(6): 566-574. PMID: 32418074. DOI: 10.1007/s12519-020-00360-6.
	47 何胜男, 唐雪梅, 张宇, 等. 川崎病相关巨噬细胞活化综合征临床分析及诊断标准初探[J]. 中华实用儿科临床杂志, 2018, 33(9): 679-683. DOI: 10.3760/cma.j.issn.2095-428X.2018.09.007.
	汪顺雨, 刘庚英, 杜忠东. 川崎病合并巨噬细胞活化综合征的临床研究进展[J]. 中华儿科杂志, 2020, 58(11): 953-956. PMID: 33120474. DOI: 10.3760/cma.j.cn112140-20200407-00354.
	Jin P, Luo Y, Liu X, et al. Kawasaki disease complicated with macrophage activation syndrome: case reports and literature review[J]. Front Pediatr, 2019, 7: 423. PMID: 31737585. PMCID: PMC6838014. DOI: 10.3389/fped.2019.00423.
	Oray M, Abu Samra K, Ebrahimiadib N, et al. Long-term side effects of glucocorticoids[J]. Expert Opin Drug Saf, 2016, 15(4): 457-465. PMID: 26789102. DOI 10.1517/14740338.2016.1140743.
	Caplan A, Fett N, Rosenbach M, et al. Prevention and management of glucocorticoid-induced side effects: a comprehensive review: gastrointestinal and endocrinologic side effects[J]. J Am Acad Dermatol, 2017, 76(1): 11-16. PMID: 27986133. DOI: 10.1016/j.jaad.2016.02.1239.
	Ritter A, Burow A, Vallelian F, et al. Systemic glucocorticoids: diagnosis, prophylaxis and treatment of side effects[J]. Praxis (Bern 1994), 2014, 103(17): 987-998. PMID: 25146942. DOI: 10.1024/1661-8157/a001747.
	53 Rahmati Y, Mollanoori H, Kakavandi N, et al. Gene expression analysis in Kawasaki disease; bioinformatics and experimental approach[J]. Inform Med Unlocked, 2020, 20: 100423. DOI: 10.1016/j.imu.2020.100423.
	Chen SJ, Dong Y, Kiuchi MG, et al. Coronary artery complication in Kawasaki disease and the importance of early intervention: a systematic review and meta-analysis[J]. JAMA Pediatr, 2016, 170(12): 1156-1163. PMID: 27749951. DOI: 10.1001/jamapediatrics.2016.2055.
	Lo MS. A framework for understanding Kawasaki disease pathogenesis[J]. Clin Immunol, 2020, 214: 108385. PMID: 32173601. DOI: 10.1016/j.clim.2020.108385.
	Kuo KC, Yang YL, Lo MH, et al. The expression of glycoprotein genes in the inflammatory process of Kawasaki disease[J]. Front Pediatr, 2020, 8: 592122. PMID: 33344384. PMCID: PMC7744457. DOI: 10.3389/fped.2020.592122.