IVIG联合泼尼松预防严重KD患儿冠脉损害可行性分析

Feasibility analysis of immunoglobulins combined with prednisone in preventing coronary artery damage in children with serious Kawasaki disease

目的评价静脉注射免疫球蛋白(IVIG)联合泼尼松预防严重川崎病(KD)患儿冠状动脉损害(CAL)的可行性。方法选择2008年10月至2014年12月在长兴县妇幼保健院及湖州市妇幼保健院住院Kobayashi评分体系≥4分的KD患儿132例,随机分为试验组68例和对照组64例,在口服阿司匹林的基础治疗上分别给予IVIG联合泼尼松和单纯IVIG治疗,评价入组前、入组后第1周、第5周的C反应蛋白(CRP)、冠状动脉内径Z值、冠状动脉瘤发生率和不良反应。结果所有患者均顺利接受治疗,两组共有68例和62例患儿完成研究。两组治疗后发热时间分别为1d(0.5～1.5)和2d(1～4),试验组低于对照组(Z=4.413,P=0.024);不良反应发生率为4.41%(3/68)和1.56%(1/64),比较差异无统计学意义(χ~2=0.911,P=0.340)。入组后1周和5周试验组冠状动脉瘤发生率均低于对照组,比较差异均有统计学意义(χ~2值分别为12.583、5.610,均P<0.05);入组后第1周和第5周试验组右冠脉近段(pRCA)、左冠状动脉(LCA)、左前降支(pLADA)和Z值最大值均低于对照组,比较差异均有统计学意义(Z值分别为4.479、6.861、5.443、8.049、7.483、5.691、6.647、10.248,均P<0.05);入组后第1周试验组CRP水平低于对照组(Z=5.373,P=0.012),第5周两组均恢复至正常水平,比较差异无统计学意义(Z=2.876,P=0.159)。结论 IVIG联合泼尼松有助于高危KD患儿CAL的预防,而且安全性良好,但合适的人群需要更多的研究证实。

Objective To evaluate the feasibility of intravenous immunoglobulin(IVIG)combined with prednisone in preventing coronary artery lesions(CAL)in children with severe Kawasaki disease(KD).Methods From October 2008 to December 2014,132 children who diagnosed with KD and Kobayashi scoring ≥4 points in Changxing Maternal and Child Health Hospital and Huzhou Maternal and Child Health-Care Center were randomly divided into experimental group(n=68)and control group(n=64).IVIG combined with prednisone and IVIG therapy alone were administered in two groups on the basis of oral aspirin.Creactive protein(CRP),Z value of coronary inner diameter,incidence of coronary artery aneurysms and adverse reactions were estimated in pre-treatment,1 week and 5 weeks after treatment.Results All patients were treated successfully.There were 68 and62 patients completing the study respectively.Fever subsidence time after treatment of two groups was 1 d(0.5-1.5)and 2 d(1-4),and that of the experimental group was shorter than the control group(Z=4.413,P=0.024).Adverse reaction rates were4.41%(3/68)and 1.56%(1/64)without statistical significance(χ~2=0.911,P=0.340).Incidence of coronary artery aneurysms of the experimental group was lower than that of the control group in 1 week and 5 weeks after treatment(χ~2 value was 12.583 and5.610,respectively,both P<0.05).Values of pRCA,LCA,pLADA and maximum Z value in the experimental group after 1 week and 5 weeks were lower than those in the control group(Zvalue was 4.479,6.861,5.443,8.049,7.483,5.691,6.647 and10.248,respectively,all P <0.05).CRP level of the experimental group was lower than the control group in 1 week after treatment(Z=5.373,P=0.012),and it recovered to normal in both groups in 5 weeks without statistical significance(Z=2.876,P=0.159).ConclusionIVIG combined with prednisone contributes to CAL prevention in high-risk children with KD and adverse reaction is low,but the appropriate patients need more studies.