C反应蛋白在静脉丙种球蛋白不敏感川崎病患儿中的临床意义

C-reactive protein level in children with Kawasaki disease unresponsive to initial intravenous immunoglobulin therapy

目的 分析川崎病患儿血清C反应蛋白（CRP）在静脉丙种球蛋白（IVIG）治疗过程中的变化,对血清CRP变化水平预测IVIG治疗不敏感患儿的疗效进行评价.方法 收集2009年1月至2012年12月在我院与广东省妇幼保健院住院的川崎病患儿;首剂IVIG（2g· kg-1·d-1）治疗后48 h退热为A组,未退热者再予相同剂量IVIG,次剂48 h退热为B组,继续/反复发热为C组.所有患儿均在首剂IVIG前、首剂48 h后（次剂IVIG前）抽取CRP.分析各组CRP变化情况及其与冠状动脉病变（CALs）的关系.结果 纳入病例146例,男性患儿84例,女性患儿62例,A组110例,B组26例,C组10例.发生CALs 20例,A、B、C组分别有8（7.3％）、5（19.2％）、7（70.0％）例.CALs阳性与阴性患儿首剂IVIG前CRP的差异无统计学意义（P＞0.05）,治疗48 h后差异具有统计学意义（P＜0.05）.A、B、C三组比较,首剂IVIG治疗前组间CRP水平、最终形成CALs的例数差异无统计学意义（P＞0.05）,48 h后差异有统计学意义（P＜0.05）,结果表明CRP水平的变化与CALs的发生有相关性.结论 对首剂IVIG不敏感的患儿更易患CALs,治疗48 h后CRP水平仍然较高者更易发生CALs;对首剂IVIG不敏感者在首剂IVIG治疗后48 h CRP仍然较高时,很可能对次剂IVIG仍然失败,应及早考虑对此类表现的患儿使用更强的抗炎手段.

Objective To analyze the serum C reactive protein （CRP） level in：children with Kawasaki disease （KD） during the treatment with intravenous immunoglobulin （iVIG）. Methods The study objects were collected from January 2009 to December 2012 in the two women and children hospitals. All the patients received IVIG of 2 g/kg daily. The Children afebrile in 48 hours after initial administration of IVIG were defined as group A. The febrile children were given second IVIG. Patients who were afebrile in 48 hours after second IVIG were defined as group B. The rest was assigned to group C. CRP levels were detected before initial IVIG and 48 hours after initial IVIG in all the children. Then the data were analyzed statistically. Results 146 children were enrolled and 84 were male and 62 were female. Group A had 110 children with 8 developing CALs （7.3%）, group B had 26 children with 5 CALs （19.2%）, group C had 10 with 7 CALs （70%）. There was significant difference in CRP level 48 hours after initial IVIG between the CALs and the negative children but no difference before initial IVIG. There were no significant differences in both CRP level and CALs between each group pairs before initial IVIG. 48 hours after administration of initial IVIG, there were significant differences in both CRP level and CALs among groups A, B, and C. It showed that there was correlation between CRP level and the development of CALs. Conclusions Patients unresponsive to IVIG are liable to develop CALs. Patients with high CRP level 48 hours after initial IVIG are liable to develop to CALs as well. The patients who are the non-responder with high CRP are likely to fail in the additional IVIG treatment. These patients may need other powerful anti-inflammation therapy earlier.