免疫球蛋白输注速度对川崎病患儿的疗效和安全性比较

Efficacy and safety associated with the infusion speed of immunoglobulin for the treatment of Kawasaki disease

目的评估免疫球蛋白(IVIG)输注速度治疗川崎病(KD)患儿的疗效和安全性差异。方法回顾性选取安庆市第一人民医院儿科诊治的KD患儿为研究对象。根据IVIG不同输注速度,将KD患儿分为12 h组和24 h组。本研究主要观察结局包括发热持续时间和冠状动脉病变(CAL)发生率。次要观察结局为IVIG无应答比例、IVIG总剂量、三线治疗比例和实验室检查指标(白细胞计数、中性粒细胞百分比、血小板计数、白蛋白、肌酐、天门冬氨酸氨基转移酶、钠离子、C-反应蛋白和免疫球蛋白G水平)。结果研究共纳入60例KD患儿,12 h组和24 h组分别有41例和19例。两组患者发热持续时间、CAL发生率、IVIG无应答比例、IVIG总剂量和三线治疗比例差异均无统计学意义(P>0.05)。与治疗前比较,12 h组和24h组患者在第2天和第7天白细胞计数、中性粒细胞百分比和C-反应蛋白显著下降(P<0.05);而血小板计数、钠离子和免疫球蛋白G显著上升(P<0.05);白蛋白呈现先下降后上升的趋势(P<0.05);肌酐和天门冬氨酸氨基转移酶未见显著变化(P>0.05)。此外,不同时间点间比较差异均无统计学意义(P>0.05)。12 h组2例患者出现不良反应事件,24 h组未发现不良反应事件。结论IVIG使用超过12 h的有效性和安全性与使用超过24 h的IVIG相似。

Objective To evaluate the efficacy and safety differences of immunoglobulin(IVIG)infusion rates in the treatment of Kawasaki disease(KD)in children.Methods KD children treated in the Department of Pediatrics of Anqing First People's Hospital were retrospectively selected as the research subjects.According to different infusion speeds of IVIG,KD children were divided into 12 h-group and 24 h-group.The main outcomes observed in this study included the duration of fever and the incidence of coronary artery lesions(CAL).The secondary observation outcomes included the proportion of IVIG non-response,total IVIG dose,proportion of third-line treatment,and laboratory examination indicators(white blood cell count,neutrophil percentage,platelet count,albumin,creatinine,aspartate aminotransferase,sodium ion,C-reactive protein,and immunoglobulin G level).Results A total of 60 children with KD were included in the study,with 41 cases in the 12 h-group and 19 cases in the 24 h-group.There were no significant differences in the duration of fever,incidence of CAL,proportion of IVIG non-response,total IVIG dose,and proportion of third-line treatment between the two groups(P>0.05).Compared with before treatment,the white blood cell count,neutrophil percentage,and C-reactive protein significantly decreased on the second day and the seventh day in both the 12 h-group and the 24 h-group(P<0.05);while platelet count,sodium ions,and immunoglobulin G significantly increased(P<0.05).Albumin showed a downward trend and then an upward trend(P<0.05),while creatinine and aspartate aminotransferase showed no significant changes(P>0.05).In addition,there were no significant statistical differences between different time points(P>0.05).Two patients in the 12 h-group experienced adverse events,while none in the 24 h-group experienced adverse events.Conclusion The efficacy and safety of IVIG administered over 12 h were similar to those administered over 24 h.