关键词: 川崎病, 自主神经功能, 冠状动脉疾病, 冠状动脉损害, 糖皮质激素, 丙种球蛋白, 儿童, 迷走神经

Abstract: Background　Children with acute kawasaki disease（KD） have reduced parasympathetic nerve function，and mainly treated with aspirin and intravenous immunoglobulin（IVIG） currently.Glucocorticoids are required for ineffective treatment in the early stage，but the conventional view is that glucocorticoids could change the excitability of vagus nerve and promote blood coagulation，increasing the risk of coronary artery tumor formation.Therefore，early application is not recommended.For children with early signs of IVIG resistance，if glucocorticoids are not applied，the disease may be further aggravated.However，there is no report about the relationship between glucocorticoids and the changes of automatic nerve function in KD children at present.Objective　To analyze the effect of glucocorticoids on changes of autonomic nerve function in children with KD and IVIG resistance.Methods　We selected 40 KD children in the Department of Pediatrics of Jingzhou Central Hospital from January 1 in 2017 to June 30 in 2019.According to the presence and absence of the coronary artery lesion（CAL），patients were divided into CAL group（n=14） and non-CAL group（n=26）.Fifteen healthy children admitted to the hospital for physical examination during the same period were selected as the control group.The changes in heart rate variability（HRV） of 24-hour ambulatory electrocardiogram in three groups were observed，including the standard deviation of normal-to-normal intervals（SDNN），standard deviation of the averages of normal-to-normal intervals in 5-minute segments（SDANN），the percentage of successive NN intervals>50 ms（pNN50） and the root-mean square of successive R-R differences as time-domain analysis（RMSSD）.We also assessed the HRV changes of 24-hour dynamic electrocardiogram in KD children with IVIG resistance before and after methylprednisolone treatment when their body temperature stabilized for 48 hours.Results　There was no significant difference in SDANN among three groups（P>0.05）.There were significant differences in SDNN，pNN50，and RMSSD among three groups（P<0.05）.The SDNN，pNN50，and RMSSD in CAL group and non-CAL group were lower than those in the control group，and CAL group had the lowest SDNN，pNN50，and RMSSD（P<0.05）.There were six cases of KD patients with IVIG resistance，all of whom were combined with CAL.There was no significant difference in SDNN，SDANN，pNN50，and RMSSD among KD patients with IVIG resistance before and after the methylprednisolone treatment（P>0.05）.Conclusion　Autonomic dysfunction exists in children with KD in acute phase.Reduced excitability of vagus nerve may be related to coronary artery dilatation.Glucocorticoids have no significant effect on the autonomic nervous function of KD children with IVIG resistance.

Key words: Kawasaki disease, Autonomic nervous system function, Coronary artery disease, Coronary artery lesion, Glucocorticoid, Gamma-globulin, Child, Vagus nerve