Monatsschrift Kinderheilkunde

, Volume 161, Issue 11, pp 1037–1041 | Cite as

Initiale Glukokortikoidtherapie beim Kawasaki-Syndrom

Empfehlung der Gesellschaft für Kinder- und Jugendrheumatologie im Rahmen der Wörlitzer Konsensusgespräche 2013
  • A. Hospach
  • U. Neudorf
  • T. Kallinich
  • J.P. Haas
  • R. Nossal
  • F. Uhlemann
  • F. Weller
  • P. Oommen
  • M. Borte
  • D. Föll
  • H.I. Huppertz
  • G. Horneff
Konsensuspapiere

Zusammenfassung

Hintergrund

Die Glukokortikoidtherapie beim Kawasaki-Syndrom wird seit Jahren kontrovers diskutiert.

Neubewertung

Eine unlängst erschienene japanische Studie von Kobayashi et al., veröffentlicht in Lancet (379:1613–1620) 2012, ergab einen deutlichen Vorteil im Hinblick auf die Prävention von koronaren Gefäßveränderungen und machte eine Neubewertung der Studien zur initialen Behandlung mit Glukokortikoiden notwendig. Zusammenfassend zeigte sich die Überlegenheit einer kombinierten Initialtherapie mit Immunglobulinen und Glukokortikoiden bei Hochrisikopatienten [erniedrigtes Serumnatrium, GPT > 100 U/l (Glutamat-Pyruvat-Transaminase), Fieberdauer ≤ 4 Tage vor Therapiebeginn, Neutrophilie > 80 %; CRP > 10 mg/dl (C-reaktives Protein), Alter < 1 Jahr, Thrombozyten < 300.000/µl].

Empfehlung

Für die oben definierte Patientengruppe wird eine initiale Behandlung mit Immunglobulinen, ASS (Azetylsalizylsäure) und Prednisolon [2 mg/kgKG (KG: Körpergewicht)] bis zur CRP-Normalisierung empfohlen.

Schlüsselwörter

Kawasaki-Syndrom  Koronare Gefäßveränderung Immunglobuline Azetylsalizylsäure Prednisolon 

Initial glucocorticoid therapy for Kawasaki syndrome

Recommendations of the Society for Pediatric and Adolescent Rheumatology within the framework of the Wörlitz consensus discussions 2013

Abstract

Background

Glucocorticoid therapy for Kawasaki syndrome has been controversially discussed for many years.

Reassessment

A recently published Japanese study from Kobayashi et al which appeared in The Lancet (379:1613–1620) in 2012 revealed a clear advantage with respect to prevention of coronary vascular alterations and necessitated a reassessment of studies on the initial treatment with glucocorticoids. In summary, a combined initial therapy with immunoglobulins and glucocorticoids was found to be superior in high-risk patients with reduced serum sodium, glutamic-pyruvic transaminase (GPT)  > 100 U/l, duration of fever ≤ 4 days before therapy initiation, neutrophilia > 80 %,C-reactive protein (CRP)  > 10 mg/dl, age < 1 year and thrombocytes < 300,000/µl.

Recommendation

For the defined patient group an initial treatment with immunoglobulins, acetylsalicylic acid (ASS) and prednisolone (2 mg/kg body weight) is recommended until normalization of CRP levels.

Keywords

Kawasaki syndrome Coronary vessel alterations Immunoglobulins Acetylsalicylic acid Prednisolone 

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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • A. Hospach
    • 1
  • U. Neudorf
    • 2
  • T. Kallinich
    • 3
  • J.P. Haas
    • 4
  • R. Nossal
    • 5
  • F. Uhlemann
    • 5
  • F. Weller
    • 6
  • P. Oommen
    • 7
  • M. Borte
    • 8
  • D. Föll
    • 9
  • H.I. Huppertz
    • 6
  • G. Horneff
    • 10
  1. 1.Pädiatrische Rheumatologie, Pädiatrie 5aPädiatrisches Zentrum, Olgahospital StuttgartStuttgartDeutschland
  2. 2.Bereiche Kardiologie und RheumatologieKinderheilkunde III, Universitätsklinik EssenEssenDeutschland
  3. 3.Klinik für Pädiatrie, Rheumatologie und AutoimmunerkrankungenCharité Universitätsmedizin Berlin, Campus MitteBerlinDeutschland
  4. 4.Deutsches Zentrum für Kinder- und JugendrheumatologieGarmisch-PartenkirchenDeutschland
  5. 5.Zentrum für angeborene Herzerkrankungen und Intensivmedizin, Pulmologie und Allergologie, Pädiatrie 3Pädiatrisches Zentrum, Olgahospital StuttgartStuttgartDeutschland
  6. 6.Prof.-Hess-KinderklinikKlinikum Bremen-MitteBremenDeutschland
  7. 7.Klinik für Kinder-Onkologie, -Hämatologie und Klinische ImmunologieHeinrich-Heine-Universität DüsseldorfDüsseldorfDeutschland
  8. 8.Fachbereich Pädiatrische Rheumatologie, Immunologie und InfektiologieKlinikum St. Georg gGmbHLeipzigDeutschland
  9. 9.Klinik für Pädiatrische Rheumatologie und ImmunologieUniversitätsklinikum MünsterMünsterDeutschland
  10. 10.Abteilung für Allgemeine Pädiatrie, Asklepios KlinikZentrum für KinderrheumatologieSankt AugustinDeutschland

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