不同剂量人免疫球蛋白对川崎病患儿临床疗效、炎性指标及心功能标志物的影响

Effects of different doses of human immunoglobulin on clinical efficacy,inflammatory index and cardiac function in children with Kawasaki disease

目的观察不同剂量人免疫球蛋白静脉注射对川崎病患儿临床疗效、炎性指标及心功能标志物的影响。方法选择2017年4月—2019年3月河北省儿童医院接受治疗的川崎病患儿90例作为研究对象。采用随机数字表法将患儿分为3组,每组30例。3组患儿入院后均给予阿司匹林肠溶片,在病程第5 d开始静脉注射人免疫球蛋白,A组为2 g·kg^-1·d^-1单剂,B组为1 g·kg^-1·d^-1单剂,C组为0.4 g·kg^-1·d^-1连用5 d。比较3组患儿临床疗效、临床症状消失时间、炎性指标、心功能标志物及不良反应。结果A组患儿总有效率为96.67%,B组为93.33%,均明显高于C组的73.33%(χ^2/P=8.907/0.044),A、B组比较差异无统计学意义(P>0.05)。A组及B组患儿发热、黏膜充血、手足发硬、颈淋巴结肿大消失时间均明显短于C组(F/P=23.129/0.000、34.750/0.000、30.728/0.000、18.517/0.000),A、B组比较差异无统计学意义(P>0.05)。治疗后3组患儿血清TNF-α、CRP及IL-6均显著下降,且A组与B组下降幅度均明显大于C组(F/P=16.243/0.000、3.193/0.046、5.262/0.001),A、B组比较差异无统计学意义(P>0.05)。治疗后3组患儿血清BNP、h-FABP水平均明显下降,且A组与B组下降幅度均明显大于C组(F/P=6.331/0.003、4.881/0.010),A、B组比较差异无统计学意义(P>0.05)。3组患儿不良反应发生率比较差异无统计学意义(P>0.05)。结论静脉注射人免疫球蛋白2 g·kg^-1·d^-1与1 g·kg^-1·d^-1单次给药疗效相当,均优于0.4 g·kg^-1·d^-1连用5 d,可明显提高川崎病患儿疗效,加速缓解临床症状,减轻炎性反应,改善心功能标志物指标。建议剂量为1 g·kg^-1·d^-1。

Objective To observe the effect of intravenous injection of different doses of human immunoglobulin on the clinical efficacy,inflammatory index and heart function of children with Kawasaki disease.Methods 90 children with Kawasaki disease who were treated in Hebei children's Hospital from April 2017 to March 2019 were selected as the study objects.The children were divided into three groups with 30 cases in each group.Three groups were given aspirin enteric coated tablets after admission.At the 5th day of the course of the disease,human immunoglobulin was injected intravenously.Group A was given 2 g·kg^-1·d^-1 single dose,group B was given 1 g·kg^-1·d^-1 single dose,and group C was given 0.4 g·kg^-1·d^-1 for 5 days.The clinical efficacy,disappearance time of clinical symptoms,inflammatory indexes,cardiac function indexes and adverse reactions of the three groups were compared.Results The total effective rate was 96.67%in group A and 93.33%in group B,which were significantly higher than 73.33%in group C(χ^2/P=8.907/0.044).There was no significant difference between group A and group B(P>0.05).The disappearance time of fever,mucosal congestion,hand and foot stiffness and cervical lymphadenopathy in group A and B were significantly shorter than that in group C(F/P=23.129/0.000,34.750/0.000,30.728/0.000,18.517/0.000).There was no significant difference between group A and group B(P>0.05).After treatment,the serum TNF-α,CRP and IL-6 of the three groups were significantly decreased,and the decreased range of group A and group B was significantly greater than that of group C(F/P=16.243/0.000,3.193/0.046,5.262/0.001).There was no significant difference between group A and group B(P>0.05).After treatment,the serum BNP and h-FABP levels of the three groups were significantly decreased,and the decreased range of group A and group B was significantly greater than that of group C(F/P=6.331/0.003,4.881/0.010).There was no significant difference between group A and group B(P>0.05).There was no significant difference in the incidence of adverse reactions among the three groups(P>0.05).Conclusion Intravenous injection of human immunoglobulin 2 g·kg^-1·d^-1 and 1 g·kg^-1·d^-1 had the same therapeutic effect,which were better than 0.4 g·kg^-1·d^-1 for 5 days.It can obviously improve the therapeutic effect of children with Kawasaki disease,accelerate the relief of clinical symptoms,reduce inflammatory reaction and improve the indexes of heart function.The recommended dose is 1g·kg^-1·d^-1.