静脉注射丙种球蛋白应用时间对川崎病疗效的影响  

Comparison of efficacy among early, conventional and late intravenous gamma globulin treatment of Kawusaki disease

作　　者：杜忠东[1] 赵地[2] 杜军保[3] 鲁珊[4] 衣京梅[5] 侯安存[6] 周忠蜀[7] 丁国芳[8] 无 

机构地区：[1]首都医科大学附属北京儿童医院心内科,100045 [2]首都儿科研究所心内科 [3]北京大学第一医院儿科 [4]北京大学第三医院儿 [5]解放军总医院儿科 [6]首都医科大学附属友谊医院儿科 [7]卫生部中日友好医院儿科 [8]中国医学科学院北京协和医学院北京协和医院儿科 [9]北京小儿川崎病流行病学调查协作组

出　　处：《中华医学杂志》2009年第26期1841-1843,共3页National Medical Journal of China

基　　金：首都医学发展基金重点项目（2007-2063）;北京自然科学基金面上项目（7092032）

摘　　要：目的探讨不同静脉注射丙种球蛋白（IVIG）应用时间对IVIG无反应性及冠状动脉并发症的影响。方法回顾性总结北京45家医院2000-2004年有IVIG治疗资料的川崎病患儿，按IVIG使用时间分成早期组（病程1～4d）、常规组（第5～9天）及晚期组（≥10d）3组。疗效评价参考IVIG无反应性及急性期（发病1～2周）和亚急性期（发病3～6周）冠状动脉并发症发生率。结果共有1052例（男680例、女372例）患儿纳入研究，年龄2个月～13．8岁，其中早期、常规及晚期组各有108例、763例和181例。早期组IVIG无反应性发生率（28．7％，31／108）显著高于常规组（11．9％，91／763）和晚期组（7．2％，13／181，均P〈0．01）。早期组和常规组相比，急性期及亚急性期冠脉并发症发生率差异均无统计学意义[17．6％（19／108）比18．3％（140／763），5．9％（4／68）比5．5％（25／452），均P〉0．05]，晚期组急性期及亚急性冠脉并发症发生率则显著高于早期和常规组[33．7％（61／181）和12．8％（15／117），均P〈0．01）]。结论川崎病病程1～4d应用IVIG增加了患儿IVIG无反应性的发生率，发病／〉10d应用则增加了冠脉并发症的发生率，第5-9天可能是最好的IVIG使用时间。Objective To compare the rates of intravenous gamma globulin （IVIG） non-responder and coronary complication among early, conventional and late IVIG treatment in children with Kawasaki disease （KD）. Methods All children with KD and IVIG treatment were retrospectively analyzed at 45 hospitals in Beijing during the 5-year period from 2000 through 2004. The time of IVIG treatment was classified as early （ Day 1 - 4）, conventional （ Day 5 - 9） and late treatment group （ Day 10 or later）. The efficacy of IVIG was judged by the rate of IVIG non-responder. Eehocardiography was used to assess the coronary complication at acute （ 1 - 2 weeks after onset） and sub-acute （3 - 6 weeks after onset） stage. Results A total of 1052 patients （680 boys, 372 gifts） aged 2 months to 13.8 years were included. They were grouped as early, conventional and late treatment in 108, 763 and 181 children respectively. The rate of IVIG non-responders was higher in early （ 28.7 % ,31/108 ） as compared with conventional （ 11.9 % ,91/ 763） and late treatment group （ 7.2%, 13/181, both P 〈 0.01 ）. The incidences of coronary complications were similar in early （ 17.6% , 19/108 and 5.9% ,4/68 ） and conventional treatment group （ 18.3% , 140/ 763 and 5.5% ,25/452）, while significantly higher in late treatment group （33.7% ,61/181 and 12.8% , 15/117） in acute and sub-acute stages （ both P 〈 0.01 ）. Conclusions IVIG treatment in children with KD for a disease duration of 1 - 4 days appeared to increase the rate of IVIG non-responders. Children with WIG given at Day 10 or later had a higher incidence of acute and sub-acute coronary complications. IVIG given at Day 5 -9 seems to be the best time for IVIG therapy in KD.

关 键 词：黏膜皮肤淋巴结综合征 丙种球蛋白类 冠状动脉并发症 

分 类 号：R686[医药卫生—骨科学]