目的 分析不同剂量静脉用丙种球蛋白（IVIG）与阿司匹林联合治疗川崎病（KD）患儿的效果及对脂代谢参数、DeRitis比值［天门冬氨酸氨基转移酶（AST）/丙氨酸氨基转移酶（ALT）］及血小板参数的影响。 方法 回顾性分析，收集医院2021年1月至2025年1月儿科收治的川崎病患儿的临床资料，所获取数据均来源于医院电子病历库与随访数据库，按IVIG使用剂量分组，其中使用大剂量IVIG（3 g/kg）联合阿司匹林治疗的KD患儿作为大剂量组，常规剂量IVIG（2 g/kg）联合阿司匹林治疗的KD患儿作为常规组，小剂量IVIG（1 g/kg）联合阿司匹林治疗的KD患儿作为小剂量组，为排除基线情况干扰，采用倾向性匹配法平衡3组基线资料，按1∶1∶1最近邻匹配法，设定卡钳值为0.03，最终获得每组39例数据，比较3组疗效、脂代谢［总胆固醇（TC）、高密度脂蛋白胆固醇（HDL-C）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-C）、载脂蛋白A1（ApoA1）、极低密度脂蛋白胆固醇（vLDL-C）］、血小板参数［血小板分布宽度（PDW）、血小板计数（PLT）、血小板压积（PCT）、平均血小板体积（MPV）、大血小板比率（P-LCR）］、冠脉Z-score值及治疗安全性。 结果 大剂量组总有效率高于小剂量组（P < 0.05）；治疗1周，大剂量组、常规剂量组HDL-C较治疗前升高（P < 0.05），3组TG较治疗前降低（P < 0.05），ApoA1较治疗前升高（P < 0.05），大剂量组治疗1周HDL-C、ApoA1高于常规剂量组与小剂量组，TG、DeRitis比值低于常规剂量组与小剂量组（P < 0.05）；治疗1周，3组PDW、PLT、MPV、P-LCR均降低（P < 0.05），大剂量组PDW、PLT、P-LCR低于常规剂量组与小剂量组，MPV低于小剂量组（P < 0.05）；随访12周，各组右冠脉、左冠脉及左前降支Z-score值均较治疗前降低（P < 0.05），大剂量组右冠脉、左冠脉及左前降支Z-score值低于常规剂量组与小剂量组（P < 0.05），常规剂量组与小剂量组上述冠脉Z-score值组间对比差异无统计学意义（P > 0.05）；3组治疗不良反应发生率、心血管相关并发症发生率比较差异无统计学意义（P > 0.05）。 结论 大剂量IVIG联合阿司匹林治疗KD疗效更高，在短期调脂、调节血小板功能方面更具优势，且可减轻肝损伤，降低DeRitis比值，减少冠脉损伤风险。

Objective To explore and analyze the efficacy of different doses of intravenous immunoglobulin （IVIG） combined with aspirin in the treatment of children with Kawasaki disease （KD）， along with its impact on lipid metabolism parameters， DeRitis ratio ［aspartate aminotransferase （AST）/alanine aminotransferase （ALT）］， and platelet parameters. Methods A retrospective analysis was carried out to gather the clinical data of KD children admitted to the pediatrics department of the hospital from January 2021 to January 2025. All the acquired data were sourced from the hospital's electronic medical record database and follow-up database. The children were grouped based on the dosage of IVIG. Specifically， children with KD treated with high-dose IVIG （3 g/kg） in combination with aspirin were assigned to the high-dose group， those treated with conventional-dose IVIG （2 g/kg） in combination with aspirin were assigned to the conventional-dose group， and those treated with low-dose IVIG （1 g/kg） in combination with aspirin were assigned to the low-dose group. To minimize the interference of baseline conditions， the propensity score matching method was employed to balance the baseline data of the three groups. Using the 1∶1∶1 nearest-neighbor matching method with a clamp value set at 0.03， 39 cases of data were ultimately obtained for each group. The therapeutic effects， lipid metabolism ［total cholesterol （TC）， high-density lipoprotein cholesterol （HDL-C）， triglycerides （TG）， low-density lipoprotein cholesterol （LDL-C）， apolipoprotein A1 （ApoA1）， very-low-density lipoprotein cholesterol （vLDL-C）］， platelet parameters ［platelet distribution width （PDW）， platelet count （PLT）， plateletcrit （PCT）， mean platelet volume （MPV）， large platelet ratio （P-LCR）］， coronary Z-score value， and safety of the three groups were compared. Results The high-dose group exhibited a higher total effective rate compared to the low-dose group （P < 0.05）. After one week of treatment， the levels of HDL-C in both the high-dose group and the conventional-dose group increased when compared to those before treatment （P < 0.05）. In all three groups， the levels of TG decreased （P < 0.05）， and the levels of ApoA1 increased （P < 0.05）. After one week of treatment， the levels of HDL-C and ApoA1 in the high-dose group were higher than those in the other two groups， whereas the ratios of TG and DeRitis were lower （P < 0.05）. After one week of treatment， the values of PDW， PLT， MPV， and P-LCR in all three groups decreased （P < 0.05）. The high-dose group had lower values of PDW， PLT， and P-LCR than the other two groups， and a lower value of MPV than the low-dose group （P < 0.05）. During the 12-week follow-up， the Z-score values of the right coronary artery， left coronary artery， and left anterior descending branch in each group were all lower than those before treatment （P < 0.05）， and the values in the high-dose group were lower than those in the other two groups （P < 0.05）， with no statistically significant difference between the other two groups （P > 0.05）. There was no statistically significant difference in the incidence of adverse reactions and cardiovascular-related complications （P > 0.05）. Conclusions High-dose IVIG combined with aspirin demonstrates a superior therapeutic effect on KD. It offers more advantages in short-term lipid regulation and platelet function regulation. Moreover， it can mitigate liver damage， reduce the DeRitis ratio， and diminish the risk of coronary artery injury.