阿司匹林在川崎病患儿中应用的专家共识

标题: 阿司匹林在川崎病患儿中应用的专家共识
title: Expert consensus on aspirin use in children with Kawasaki disease
版本: 原创版
version: Original
分类: 专家共识
classification: Experts consensus
领域: 治疗
field: Treatment
国家和地区: 中国
Country and region: China
指南使用者: 本共识的使用人群包括所有儿童风湿免疫科及儿童心血管内科医师及全科医师。
Guide users: Use of this consensus includes all pediatric rheumatology and pediatric cardiovascular physicians and general practitioners.
证据分级方法: The evidence recommendation grading evaluation, formulation and evaluation method (GRADE) was used to determine the recommendation level of a clinical issue in this consensus according to the credibility level of literature or data under the guidance of the GRADE manual.
Evidence grading method: 采用证据推荐分级评估、制定与评价方法(GRADE),以GRADE手册为指导,根据文献或资料的可信等级,确定某一临床问题在本共识中的推荐等级。
制定单位: 陕西省川崎病诊疗中心;陕西省人民医院儿童病院
Formulating unit: Shaanxi Kawasaki Disease Diagnosis and Treatment Center; Children's Hospital of Shaanxi Provincial People's Hospital
注册时间: 2021-10-09
Registration time:
注册编号: IPGRP-2021CN321
Registration number:
指南制订的目的: 目前国外国内已有很多研究表明阿司匹林治疗川崎病具有良好疗效、安全性、依从性。然而,阿司匹林治疗川崎病也存在一些问题和挑战、争议:如使用时间最佳剂量、使用疗程、不良反应等问题。尤其是阿司匹林剂量问题:尽管已被证明可显著降低冠状动脉异常的风险,阿司匹林的最佳剂量尚不清楚,导致实践中存在显著差异,欧美人群使用剂量80-100mg/kg/日,亚洲人群使用剂量30-50mg/kg/日。高剂量阿司匹林用作抗炎剂,而低剂量阿司匹林具有抗血栓作用。这两个作用被认为在KD的初始阶段是有用的,但多篇报道提示ASA似乎并未降低冠状动脉异常的发生频率,且考虑到阿司匹林的不良反应,尤其是高剂量的阿司匹林导致消化道溃疡、出血、鼻出血、肝肾功损害等不良反应,关于阿司匹林的效用和最佳剂量的问题就值得商榷。
Purpose of the guideline: At present, many studies have shown that aspirin has good efficacy, safety and compliance in the treatment of Kawasaki disease at home and abroad. However, there are also some problems, challenges and controversies in the treatment of kawasaki disease, such as the optimal dose, duration of use and adverse reactions. In particular, there is the issue of aspirin dose: although it has been shown to significantly reduce the risk of coronary artery abnormalities, the optimal dose of aspirin is not known, leading to significant differences in practice between 80-100mg/kg/ day in European and American populations and 30-50mg/kg/ day in Asian populations. High-dose aspirin is used as an anti-inflammatory, while low-dose aspirin has antithrombotic effects. These two effects are considered to be useful in the initial stage of KD, but several reports suggest that ASA does not seem to reduce the frequency of coronary artery abnormalities, and considering the adverse reactions of aspirin, especially high-dose aspirin can lead to gastrointestinal ulcer, bleeding, nasal bleeding, liver and kidney function damage and other adverse reactions, Questions about aspirin's utility and optimal dose are open to debate.