不同浓度免疫球蛋白静脉注射治疗小儿川崎病的效果及其对PGE2水平和免疫学效应的影响

Effect of intravenous immunoglobulin of different concentrationsin kawasaki disease in children and its influence on PGE2 level and immunological effect

目的探讨不同浓度免疫球蛋白静脉注射治疗小儿川崎病(KD)的效果及其对前列腺素E2(PGE2)水平和免疫学效应的影响。方法将我院收治的92例KD患儿随机分为大剂量组(静脉注射免疫球蛋白2 g/kg)和小剂量组(静脉注射免疫球蛋白1 g/kg),每组46例。比较两组主要症状消退时间、治疗前、后血清PGE2水平、免疫学指标、冠脉病变发生情况及不良反应发生情况。结果两组发热、黏膜充血、淋巴结肿大和手足肿胀等主要症状消退时间无显著差异(P>0.05)。治疗后,两组患儿血清PGE2水平显著降低(P<0.05);治疗前、后组间比较,血清PGE2水平无显著差异(P>0.05)。治疗后,两组患儿血清IgG水平、CD8+显著升高,CD3+、CD4+和CD4+/CD8+均显著降低(P<0.05),但血清IgM和IgA水平无显著差异(P>0.05)。治疗后,大剂量组血清IgG水平显著高于小剂量组(P<0.05)。两组冠脉病变发生率及各不良反应发生率无显著差异(P>0.05)。结论 1 g/kg×1次与2 g/kg×1次IVIG治疗KD效果及其对冠状动脉的保护效应相当,且对患儿血清PGE2水平和免疫学效应影响无明显差异,1 g/kg×1次更符合药物经济学要求。

Objective To investigate the effect of intravenous immunoglobulin of different concentrations in the treatment of Kawasaki disease(KD)in children and its influence on prostaglandin E2(PGE2)level and immunological effect.Methods A total of 92 children with KD admitted in our hospital were randomly divided into high-dose group(intravenous immunoglobulin 2 g/kg)and low-dose group(intravenous immunoglobulin 1 g/kg),with 46 cases in each group.The main symptoms subsidence time,serum PGE2 levels before and after treatment,levels of immunological indexes,the incidence of coronary artery disease and adverse reactions were compared between the two groups.Results There were no significant differences in the disappearance time of main symptoms such as fever,mucosal hyperemia,lymph node enlargement and hand-foot swelling between the two groups(P>0.05).After treatment,the serum PGE2 levels of the two groups significantly decreased(P<0.05).There was no significant difference in serum PGE2 level between the two groups before and after treatment(P>0.05).After treatment,the levels of serum IgG and CD8+in the two groups significantly increased,and the levels of CD3+,CD4+and CD4+/CD8+significantly decreased(P<0.05),but the levels of serum IgM and IgA were not significantly different(P>0.05).After treatment,the serum IgG level in the high dose group was significantly higher than that in the low dose group(P<0.05).There were no significant differences in the incidence of coronary artery disease and Varions adverse reactions between the two groups(P>0.05).Conclusion The therapeutic effect of 1 g/kg×1 time and 2 g/kg×1 time IVIG on KD and its protective effect on coronary artery were similar,and there were no significant differences in serum PGE2 level and immunological effect between the two groups.1g/kg×1 is more in line with pharmacoeconomics requirements.