不同静脉丙种球蛋白给药方法治疗川崎病的效果比较

Effects of three intravenous gamma globulin regimens on Kawasaki disease and relevant coronary complication rates in pediatric patients:a comparative study

目的探讨不同方法丙种球蛋白静脉注射(IVIG)对川崎病患儿疗效及冠状动脉并发症的影响。方法回顾性分析北京45家医院2000—2004年间川崎病患儿的 IVIG 治疗情况,共1052例(男680例、女372例)患儿纳入研究,年龄2月～13.8岁。按 IVIG 给药方法分成2g/kg 单次给药(单次组)、1 g·kg^(-1)·d^(-1)连续2 d(2 d 组)及400～600 mg·kg^(-1)·d^(-1)连续4～5 d(4～5 d 组)3组。观察指标参考 IVIG 无反应性发生率及急性(发病1～2周)和亚急性期(发病3～6周)冠状动脉并发症发生率。结果单次组、2 d 组和4～5 d组分别有292、656和104例患儿。2 d 组 IVIG 无反应性发生率(61/292,20.9%)显著高于单次组(65/656,9.9%)及4～5 d 组(9/104,8.7%,P<0.01)。急性期冠状动脉并发症、心包积液、二尖瓣反流的发生率3组间差异无统计意义,但亚急性期单次组冠脉并发症(5.1%)及冠状动脉瘤发生率(1.6%)低于4～5 d 组(11.6%和4.7%)和2 d 组(9.8%和5.4%,P=O.035～0.047)。结论 IVIG 2g/kg 单次给药方案可减少冠状动脉并发症和 IVIG 无反应性的发生率,可能是川崎病目前较好的 IVIG 治疗方案。

Objectives To compare the effects on Kawasaki disease （KD） of 3 different intravenous gamma globulin （IVIG） regimens and coronary complication rates in children with Kawasaki disease （KD）. Methods The clinical data of 1052 children with KD treated in 45 hospitals in Beijing from 2000 through 2004, 680 male and 372 female, aged 2 months - 13.8 years, 656 （60.1%） undergoing IVIG 2 g/kg for one dose （ single dose group）, 292 （ 26.7 % ） undergoing 1 g·kg^-1·d^-1 for 2 days （2 d group）, and 104 （9.5%） undergoing 400 -600 mg·kg^-1·d^-1 for 4-5 d （4 -5 d group） in addition of oral administration of aspirin, were analyzed retrospectively. Echocardiography was used to assess the occurrence of coronary complications 1 - 2 weeks after onset （ acute stage） and 3 - 6 weeks after onset （ subacute stage）. Results The rate of IVIG non-responder of the 2 d group was 20.9%, significantly higher than those of the single dose group and 4- 5 d group （9.9% and 8.7% respectively, both P 〈 0.01 ）. There were no significant differences in rates of coronary complication, pericardial effusion, and mitral regurgitation at the acute stage among the 3 groups （ all P 〉 0.05 ）. However, the rates of coronary complication and of coronary aneurysm at the sub-acute stage of the single dose group were 5. 1% and 1.6% , significantly lower than those of the 4 -5 d group （11.6% and 4.7% ） and 2 d group （9.8% and 5.4%, P =0.035 -0.047 ） were significantly lower in single dose group （5.1% and 1.6% ） as compared to those in4-5 d group and （11.6% and4.7%） and2 d group （9.8% and5.4%） （P=0.035-0.041）. Conclusion IVIG 2 g/kg in a single dose has lower rates of coronary complications and IVIG non-respenders in children with KD, and is recommended for initial KD therapy.