英夫利西单抗与 IVIG 治疗 IVIG 初治无效川崎病效果比较

Comparison the effect of Infliximab and intravenous immunoglobulin in the treatment of children with Kawasaki disease refractory to initial IVIG therapy

目的比较英夫利西单抗与静脉注射免疫球蛋白(intravenous immunoglobulin, IVIG)治疗 IVIG 初治无效川崎病的效果。方法选取2013年1月至2017年10月本院儿科诊断的88例 IVIG 初治无效川崎病患儿为研究对象,其中22例患儿接受英夫利西单抗治疗(英夫利西单抗组),66例患儿追加 IVIG 治疗(IVIG复治组)。比较两组患儿持续发热时间、不同时间点的退热率、冠状动脉病变(coronary artery lesions,CALs)发生率及不良反应发生情况。结果英夫利西单抗组患儿平均持续发热时间[(16.8±2.9)小时]显著短于 IVIG 复治组[(56.3±8.6)小时](P<0.001),不同时间点退热率均显著高于 IVIG 复治组(P<0.05)。治疗后第10天,英夫利西单抗组1例患儿出现CALs,治疗后第56天恢复正常; IVIG 复治组9例患儿出现CALs,治疗后第56天病变仍存在。 IVIG 复治组1例患儿出现严重不良反应(治疗后3周川崎病复发);英夫利昔单抗组患儿便秘发生率显著低于 IVIG 复治组(P<0.05),治疗期间无一例患儿发生支气管炎; IVIG 复治组8例患儿发生支气管炎。两组患儿其他不良反应发生率比较均无显著差异(P>0.05)。结论英夫利西单抗能加速川崎病患儿退热,缩短患儿持续发热时间,且安全性良好,可有效治疗 IVIG 初治无效川崎病。

Objective To compare the different effects of Infliximab and intravenous immunoglobulin(IVIG)in the treatment of children with Kawasaki disease refractory to initial IVIG therapy.Method 88 children with Kawasaki disease who refractory to initial IVIG therapy in our hospital from January 2013 to October 2017 were included.22 children in Infliximab group were treated with Infliximab and 66 children in IVIG retreated group received an additional dose of IVIG.The duration of fever,the rate of defervescence at different time points,the incidence of coronary artery lesions(CALs)and the incidence of adverse reactions were compared between the two groups.Result The average duration of fever in Infliximab group[(16.8±2.9)hours]was significantly shorter than IVIG retreated group[(56.3±8.6)hours](P<0.001),and the rate of defervescence at different time points were significantly higher than IVIG retreated group(P<0.05).On the tenth day after treatment,1 children in Infliximab group developed CALs,and returned to normal after fifty-sixth days of treatment.In IVIG retreatment group,9 children developed CALs,and fifty-sixth days after treatment,the disease still existed.1 case of children in IVIG retreated group had serious adverse reactions(Kawasaki disease recurred 3 weeks after treatment).The incidence of constipation in Infliximab group was significantly lower than that of IVIG retreated group(P<0.05),no bronchitis was found in one case during the treatment and 8 cases of bronchitis in IVIG retreated group.There were no significant differences in the incidence of other adverse reactions between the two groups(P>0.05).Conclusion Infliximab can accelerate the fever of children with Kawasaki disease and shorten the duration of defervescence.It is safe and effective in the treatment of Kawasaki disease refractory to initial IVIG therapy.