儿童静脉注射丙种球蛋白治疗不敏感川崎病的临床特点及方法研究

Clinical features and methodology of intravenous immunoglobulin G therapy in children Kawasaki disease

目的探讨儿童静脉注射丙种球蛋白(IVIG)不敏感川崎病的临床特点及治疗方法。方法选择本院收治的50例川崎病患儿作为研究对象,回顾性分析临床资料,其中20例患者为儿童静脉注射丙种球蛋白(IVIG)不敏感川崎病患者,为不敏感组,其他30例为敏感组。然后对比分析两组之间的白细胞(WBC),中性粒细胞(N),外周血血红蛋白(Hb),C反应蛋白(CRP),白蛋白(ALB),乳酸脱氢酶(LDH),血沉(ESR)等指标,以及对比伴随冠状动脉病变和不伴随冠状动脉病变的患者的类似指标,对患者的IVIG耐药高危因素进行logistic回归分析。结果敏感组的男女比例明显低于不敏感组,敏感组的ALB显著高于不敏感组(P<0.05)。经过logistic回归分析发现,性别和ALB是导致IVIG耐药的高危因素。敏感组与不敏感组,伴随冠状动脉病变和不伴随冠状动脉病变的患者之间的其他指标差异无统计学意义。结论 IVIG不敏感川崎病患儿容易发生冠状动脉病变,性别和ALB可能是患者IVIG耐药的高危影响因素,临床主要要有继续IVIG治疗和糖皮质激素(GCs)治疗等。

Objective To explore the clinical features and treatment of the children with Kawasaki disease who are not sensitive to intravenous immunoglobulin G（IVIG）.Methods Fifty children with Kawasaki disease from the hospital were chosen as subjects,retrospective analysis was performed in the clinical data of 20 Kawasaki disease children who got IVIG,but they were not sensitive,and this group served as non sensitive group,the other 30 cases for sensitive group.Then,comparative analysis was made between the two groups in white blood cell（WBC）,neutrophils（N）,peripheral blood hemoglobin（Hb）,C-reactive protein（CRP）,albumin（ALB）,lactate dehydrogenase（LDH）,erythrocyte sedimentation rate（ESR） and other indicators,as well as comparison involved with and without coronary artery disease patients among the similar indicators,the IVIG-resistant high-risk factors in the patients were processed with logistic regression analysis.Results The proportion of men and women in the sensitive group was significantly higher than that of non sensitive group.Logistic regression analysis showed that gender and ALB were two leading risk factors for IVIG-resistance.The other indexes showed no significant difference in comparisons between non sensitive group and sensitive group,or between with and without coronary artery disease patients.Conclusion IVIG insensitive Kawasaki disease is prone to coronary artery disease,gender and ALB IVIG-resistant patients may be at high risk factors,clinical treatment and GCs should continue IVIG therapy.