糖皮质激素联合丙种球蛋白治疗丙种球蛋白无反应型川崎病的临床疗效

Clinical study of combination treatment of glucocorticoid and intravenous immunoglobulin(IVIG)in IVIG unresponsive Kawasaki disease

目的分析糖皮质激素联合静脉注射丙种球蛋白(IVIG)治疗IVIG无反应型川崎病的临床效果。方法选取2016年6月至2020年6月于我院住院治疗确诊为IVIG无反应型KD患儿68例作为研究对象,依据再次治疗是否联合使用糖皮质激素分为A组(IVIG)和B组(糖皮质激素联合IVIG),其中A组42例、B组26例。分析两组患儿总热程、热退时间、冠状动脉损害情况及再次治疗前、治疗后1周实验室指标白细胞(WBC)、血小板(PLT)、超敏C反应蛋白(hsCRP)、血沉、IL-6的变化。结果 B组患儿的总热程、热退时间均短于A组,差异有统计学意义(P<0.05)。B组患儿出现冠状动脉扩张、冠状动脉瘤发生率略高于A组,但差异无统计学意义(P>0.05)。B组治疗后WBC高于A组,B组WBC治疗前后差值低于A组;B组治疗前hsCRP及治疗前后hsCRP差值均高于A组;B组治疗后IL-6低于A组,B组IL-6治疗前后差值高于A组,差异均有统计学意义(P<0.05)。结论两种方案治疗IVIG无反应型川崎病均有效;两组冠状动脉损害发生率,差异无统计学意义,糖皮质激素联合IVIG没有增加冠状动脉病变的发生风险;不同治疗方案对两组患儿治疗前后WBC、hsCRP、IL-6水平存在影响,与单用IVIG治疗相比,糖皮质激素联合IVIG在KD急性期能更好的控制IVIG无反应型KD患儿的炎症指标并能缩短发热时间。

Objective To investigate the combination treatment of glucocorticoid and intravenous immunoglobulin(IVIG)in IVIG unresponsive Kawasaki disease(KD).Methods Date of 68 cases with initial IVIG unresponsive KD in Hangzhou Children's Hospital were collected from June 2016 to June 2020 and were divided into group A(IVIG)and group B(glucocorticoid combined with IVIG)according to re-treatment methods.42 cases were in group A and 26 cases were in group B.The whole fever time,duration of fever after re-treatment,coronary arteries lesion,laboratory examina-tion results of WBC,PLT,hsCRP,ESR,IL-6 before and one week after re-treatment were analyzed in the two groups.Results The whole fever time,duration of fever after re-treatment of group B were shorter than that of group A(P<0.05).The incidence of coronary artery dilatation and coronary artery aneurysm in group B were slightly higher than those in group A,but there were no significant differenc(P>0.05).The WBC of group B after re-treatment was higher than that of group A,and the difference of group B before and re-treatment was lower than that of group A.The difference of hsCRP before and after re-treatment in group B was higher than that in group A.After re-treatment,IL-6 in group B was lower than that in group A,and the difference of IL-6 in group B before and after re-treatment was higher than that in group A,with statistical significance(P<0.05).Conclusion Both schemes were effective in the treatment of IVIG unresponsive KD.There was no significant difference in the incidence of coronary artery lesion between the two groups.Glucocorticoid combined with IVIG did not increase the risk of coronary artery lesion.Different treatment regimens had effects on the levels of WBC,hsCRP and IL-6 in the two groups before and after re-treatment.Compared with IVIG alone,glucocorticoid combined with IVIG in the acute stage of KD could better control the inflammatory indexes of IVIG unresponsive KD children and shorten the time of fever.