静脉注射丙种球蛋白不敏感川崎病16例临床分析

Clinical characterisrics of 16 cases with Kawasaki disease insensitivity to intravenous immunoglobulin

目的分析静脉注射丙种球蛋白(IVIG)不敏感川崎病(KD)的临床特点。方法回顾性分析2002年1月～2006年12月该院住院治疗的112例川崎病患儿。结果IVIG不敏感川崎病共16例(14.3%)。IVIG不敏感川崎病中男女性别比为4.32∶1,明显高于IVIG敏感川崎病(1.8∶1)(P<0.05)。两组川崎病年龄构成差异无显著性(P>0.05)。IVIG不敏感川崎病中有冠状动脉改变者(68.8%),明显高于IVIG敏感川崎病者(45.8%)(P<0.05)。川崎病患儿发生IVIG耐药的可能危险因素有外周血白细胞、中性粒细胞比例、血红蛋白、血小板、C反应蛋白、血沉、血浆白蛋白及性别等。IVIG不敏感川崎病患儿中14例通过复用IVIG后临床症状得以缓解,仅2例在应用IVIG后症状仍不能控制而加用激素治疗有效。结论IVIG不敏感川崎病男性多见,并与外周血白细胞、中性粒细胞比例、血红蛋白、血小板、血沉、C反应蛋白、血浆白蛋白等因素有关;IVIG不敏感川崎病较IVIG敏感组更易发生冠状动脉病变;治疗上可采取重复1、2次IVIG,或阿司匹林联合IVIG基础上加用激素对IVIG不敏感川崎病治疗有较好疗效。

[Objective] To analyse clinical characteristics of 16 cases with Kawasaki disease （KD） insensitivity to intravenous immunoglobulin（IVIG）. [Method] Retrospect analyse 112 cases with KD inpatient during 2002 to 2006. [Results] There are 16 eases with KD insensitivity to IVIG （14.3%）, and there is more boy than girl in this group, the ratio is 4.32：1, while the ratio is 1.8：1 in the group sensitivity to IVIG （P 〈0.05）. There is no difference in age in two groups （P 〉0.05）, and higher coronary artery alter in group of insensitivity （68.8%） to IVIG than that of sensitivity to IVIG （45.8%） （P 〈0.05）. The risk factors of KD patient resistant to IVIG probably including gender, periphral blood white eell,neutrophil granulocyte, haematoglobin, blood plate, C reactive protein, blood sedimentation, plasma protein, et al. 14 cases had to use IVIG again, and 2 cases had to use steroid after IVIG to control acute symptoms. [Conclusion] There is more boy than girl in group with KD resistant to IVIG. The risk factors of KD patient resistant to IVIG probably including gender, periphral blood white cell, neutrophil granulocyte, haematoglobin, blood plate, C reactive protein, blood sedimentation, plasma protein, et al. It may be effective to use IVIG again, or Asprin and IVIG and steroid to KD patients resistant to IVIG.