静脉注射免疫球蛋白无反应性川崎病的危险因素分析

Analysis of risk factors of intravenous immunoglobulin anergy Kawasaki disease

目的 探讨静脉注射免疫球蛋白（IVIG）无反应性川崎病（KD）的相关危险因素、不同处理方案及预后,以减少冠状动脉损伤（CALs）的发生。方法 回顾性分析2011年4月~2014年3月在本院住院的476例KD患者,分别对IVIG敏感组和IVIG无反应组的性别、发病月龄、临床表现、实验室检查、诊断类型、IVIG开始使用时间及剂量等因素进行比较。根据对IVIG无反应性KD的处理方案不同,分为再次IVIG组、再次IVIG＋糖皮质激素（GCS）组与IVIG敏感组,比较CALs发生率。结果 （1）IVIG无反应组的外周血WBC、血Na＋较IVIG敏感组降低,而ESR明显升高,IVIG剂量较低（均P〈0.05）。（2）再次IVIG或再次IVIG＋GCS组的CALs发生率与IVIG敏感组比较差异无统计学意义（P〉0.05）。结论 外周血WBC、血Na＋降低和ESR升高及IVIG剂量不足是IVIG无反应发生的高危因素,及时再次IVIG或再次IVIG＋GCS处理均能明显降低CALs的发生。

Objective To explore the risk factors, different treatment options and prognosis of intravenous immunoglobulin （IVIG） anergy Kawasaki disease （KD） in order to reduce the occurrence of coronary artery lesions （CALs）. Methods A retrospective analysis on 476 KD patients having been admitted to our hospital from Apr. 2011 to Mar. 2014 was made, and the sex, disease months, clinical manifestation, laboratory examination, diagnosis type, injection time and dose of IVIG in IVIG intensive group and IVIG anergy group were compared. According to different treatment schemes for IVIG anergy in KD, the patients were divided further into reapplied IVIG group, reapplied IVIG ＋ glucocorticoid （GCS） group, and IVIG sensitive group, and the incidences of CALs were compared. Results （ 1 ） Compared with those in IVIG sensitive group, the peripheral blood WBC and blood Na ~ in IVIG anergy group decreased while ESR increased obviously and IVIG dose was lower （ （ all P 〈 0.05 ）. （2） The incidence of CALs in reapplied IVIG group or reapplied IVIG ＋ GCS group had no significant difference from that in IVIG sensitive group （P 〉 0.05 ）. Conclusion Decrease of peripheral blood WBC and blood Na ＋ , increase of ESR, and insufficiency of IVIG dose are high risk factors of IVIG anergy, and timely reapplication of IVIG or reapplication of IVIG ＋ GCS in treatment can reduce the incidence of CALs significantly.