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

摘要： 背景　急性期川崎病（KD）患儿副交感神经功能降低，目前主要使用阿司匹林及静脉丙种球蛋白（IVIG）治疗，治疗无效者需加用糖皮质激素，但传统观点认为糖皮质激素可改变迷走神经兴奋性，并促进血液凝固，增加冠状动脉瘤形成风险，不建议早期应用。对于早期具有IVIG耐药征象的患儿如果不早期应用糖皮质激素有可能导致病情进一步加重。目前关于糖皮质激素对KD患儿自动神经功能变化的影响尚无报道。目的　分析糖皮质激素对IVIG非敏感性急性KD患儿自主神经功能变化的影响。方法　选择2017-01-01至2019-06-30在荆州市中心医院儿科住院的急性期KD患儿40例，按有无合并冠状动脉损害（CAL）分为合并CAL组（14例）和不伴CAL组（26例），选取同期入院体检的健康儿童15例为对照组。观察3组儿童24 h动态心电图心率变异性（HRV）变化：全程正常窦性心搏间期标准差（SDNN）、每5 min节段平均心搏间期均值标准差（SDANN）、心搏间期差值>50 ms个数百分比（pNN50）、全程相邻心搏间期差值均方根值（RMSSD），并观察IVIG非敏感性KD患儿在应用甲泼尼龙治疗前及甲泼尼龙治疗后体温稳定48 h时24 h动态心电图HRV变化。结果　对照组、不伴CAL组、合并CAL组SDANN比较，差异无统计学意义（P>0.05）。对照组、不伴CAL组、合并CAL组SDNN、pNN50、RMSSD比较，差异有统计学意义（P<0.05）；合并CAL组、不伴CAL组SDNN、pNN50、RMSSD较对照组均降低，合并CAL组SDNN、pNN50、RMSSD较不伴CAL组均降低（P<0.05）。共有6例IVIG非敏感性KD患儿，且均合并CAL。IVIG非敏感性KD患儿加用甲泼尼龙治疗后体温稳定48 h时SDNN、SDANN、pNN50、RMSSD与加用甲泼尼龙前比较，差异均无统计学意义（P>0.05）。结论　急性期KD患儿存在自主神经功能紊乱，迷走神经兴奋性降低可能与冠状动脉扩张有关。糖皮质激素对IVIG非敏感性KD自主神经功能无明显影响。

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