静脉输注丙种球蛋白防治川崎病冠状动脉病变的疗效

Efficacy of Intravenous Gammaglobulin in Prevention and Treatment of Coronary Artery Lesion in Kawasaki Disease

目的评价静脉输注丙种球蛋白(IVIG)治疗和预防川崎病(KD)冠状动脉病变(CAL)的疗效,探讨IVIG疗效的影响因素。方法对314例KD患儿的临床资料进行回顾性对比观察。按治疗将患儿分为阿司匹林(ASA)+IVIG组和ASA组,观察两组CAL发生、恢复情况、不同时机不同剂量IVIG治疗KD疗效、临床及实验室指标,急性期出现CAL者分别于病程1,3,6,12个月复查。结果ASA+IVIG组CAL发生率34.3%,ASA组56.0%,两组比较P<0.001。应IVIG2.0g/kg或1.0g/kg以及在病程3～10d应用IVIG,CAL发牛率低,P<0.05。22.2%CAL发生在IVIG治疗后;13.4%CAL在病程12个月仍不能恢复正常,多数为IVIG治疗开始时间超过10d者。ASA+IVIG组住院时间、退热时间、总热程缩短,血小板计数、血沉、C反应蛋白显著降低(P<0.05)。IVIG耐药病例占10.5%。结论IVIG治疗可显著缩短KD病程和降低CAL发生,但对川崎病CAL防治并非人们所预期的那样有效,实际疗效需要再评价。

Objective To evaluate the efficacy of intravenous garmnaglobulin （IVIG） in the prevention and treatment of coronary artery lesion （CAL） in Kawasaki disease （KD） and the related factors influencing the IVIG efficacy. Methods Three hundred and fourteen children with KD were reviewed retrospectively in a contrast study. Results The incidence rate of CAL was 34.3% in IVIG ＋ acetylsalicylic acid（ASA） group and 56.0 % in ASA group（ P 〈 0. 001 ）. The incidence of CAL was reduced in the group in which 2.0 g/kg or 1.0 g/kg IVIG was administered. CAL occurred less frequently when IVIG was administered at 3 - 10 days of the course, P〈 0.05. About 22.2 % of the children with KD treated with IVIG still developed CAL. About 13.4 % of the CAL treated with IVIG was not recovered at the 12th month of the course. The drug - resistant cases accounted for 10.5% in this group. Conclusion IVIG treatment can remarkably shorten the course of children with KD and decrease the incidence of coronary artery events, but the efficacy of IVIG in the prevention and treatment of KD disease is not as expected by people, therefore, reevaluation of the practical efficacy of IVIG is required.