静脉注射丙种球蛋白无反应型川崎病56例临床分析  

Clinical Features in Patients With Intravenous Inununoglobin Resistant Kawasaki Disease

作　　者：胡坚[1] 张庆[1] 傅松龄[1] 龚方戚[1] 朱卫华[1] 解春红[1] 汪伟[1] 

机构地区：[1]浙江大学医学院附属儿童医院心血管内科,浙江省杭州市310003

出　　处：《中国循环杂志》2009年第4期273-276,共4页Chinese Circulation Journal

摘　　要：目的:分析静脉注射丙种球蛋白(ⅣIG)无反应型川崎病患儿的临床特点。方法:对2007-01至2008-06期间在我院住院治疗的332例川崎病患儿进行病例回顾性分析。结果:ⅣIG无反应型川崎病共56例(占16.9%)。ⅣIG无反应型川崎病中男女性别比为4.09:1,明显高于ⅣIG敏感川崎病1.38:1(P<0.05)。ⅣIG无反应型川崎病中有较严重冠状动脉扩张或冠状动脉瘤者11例(19.6%),明显高于ⅣIG敏感川崎病(2.5%)(P<0.05)。川崎病患儿发生ⅣIG耐药的可能危险因素有外周血白细胞、中性粒细胞比例、血红蛋白、红细胞压积、血小板、C反应蛋白、血沉、血浆白蛋白、乳酸脱氢酶等。ⅣIG无反应型川崎病患儿中33例通过复用ⅣIG后临床症状得以缓解,仅11例在复用:ⅣIG后症状仍不能控制而加用激素治疗。结论:ⅣIG无反应型川崎病较ⅣIG敏感川崎病更易发生冠状动脉病变。复用ⅣIG及必要时加用激素对ⅣIG无反应型川崎病治疗有较好疗效。Objective：To investigate the clinical features and risk factors in patients with intravenous immunoglobin（IVIG） resistant Ka- wasaki disease. Methods ：A total of 332 patients with Kawasaki disease from January 2007 to June 2008 treated in our hospital were retrospectively analyzed. Results ：There were 56/332 （ 16. 9% ）patients failed to initial IVIG treatment. Among those patients, the ratio of male to female was 4.09： 1, that was significantly higher than IVIG responsive Kawasaki disease patients （ 1.38 ： 1 ）, （ P 〈 0. 05 ）. The patients with IVIG resistant Kawasaki disease had higher and severer coronary artery lesions（ 19.6% ）than those of IVIG responsive patients （2.5 % ）, （ P 〈 0. 05）. Compared with IVIG responsive patients, the possible risk factors for IVIG resistant Kawasaki disease were white blood cell, neutrophil ratio, hemoglobulin, hematocrit, platelet count, C-reactive protein, erythrocyte sedimentation rate, albumin and lactate dehydrogenase, etc. In male patients, decreased hematocrit and decreased albumin might be related to IVIG resistant. Additional infusion of IVIG effected in most IVIG resistant patients（ 33/56 ） ;steroid treatment was used to 11 patients in whom the additional infusion of IVIG had no effects. Conclusion：The patients with IVIG resistant Kawasaki diseases had the higher risk for coronary artery lesions. Additional infusion of IVIG and steroid treatment with antiplatelet and anticoagulant medications showed good effects in patients with IVIG resistant Kawasaki disease.

关 键 词：静脉注射丙种球蛋白 无反应型 川崎病 临床分析 IVIG 冠状动脉扩张 外周血白细胞 冠状动脉病变 

分 类 号：R392-33[医药卫生—免疫学] R714.510.8[医药卫生—基础医学]