川崎病并发肝功能损害患儿的临床特点及其与丙种球蛋白无反应的关系  

Kawasaki Disease Combined with Impaired Liver Function and Its Relation with IVIG Resistance

作　　者：王志[1] 张若松[1] 

机构地区：[1]浙江省宁波市妇女儿童医院儿二科,315012

出　　处：《中国全科医学》2013年第15期1719-1721,共3页Chinese General Practice

摘　　要：目的探讨川崎病(KD)并发肝功能损害患儿的临床特点及其与丙种球蛋白(IVIG)无反应的关系。方法选取2008年1月—2012年1月我院收治的KD患儿167例,其中并发肝功能损害(肝功能异常组)41例,未并发肝功能损害(肝功能正常组)126例。比较两组患儿性别、年龄、治疗前发热时间、住院时间、是否入住ICU、IVIG无反应率、冠状动脉异常、冠状动脉瘤发生率、入院时丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、γ谷氨酰转肽酶(GGT)、清蛋白、总胆红素、C反应蛋白、红细胞沉降率(ESR)、白细胞计数(WBC)及血小板计数(PLT)的差异,并分析IVIG无反应的影响因素。结果肝功能正常组和肝功能异常组患儿性别、住院时间、入住ICU率,冠状动脉异常、冠状动脉瘤发生率及清蛋白、总胆红素、C反应蛋白、ESR、WBC、PLT比较,差异均无统计学意义(P>0.05);两组患儿年龄、治疗前发热时间、IVIG无反应率及ALT、AST、GGT水平比较,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,清蛋白和总胆红素进入回归模型。结论肝功能损害在急性KD患儿中常见,且与IVIG无反应相关。低蛋白血症和胆红素升高是IVIG无反应的危险因素。Objective To investigate the clinical features of Kawasaki disease （KD） patients combined with abnormal liver function and its relation with IVIG resistance. Methods 167 KD children admitted to our hospital from January 2008 to Jan- uary 2012 were divided into abnormal liver function group （41 cases） and normal liver function group （ 126 cases） . The gender, age, pre - treatment duration of fever, hospitalization, ICU admission, IVIG non - response rate, the incidence of coronary ar- tery abnormalities and coronary artery aneurysms, glutamate aminotransferase enzyme （ALT）, aspartate aminotransferase trans- ferase enzyme （AST）, gamma glutamyl transferase （GGT）, albumin, total bilirubin, C -reactive protein, erythrocyte sedi- mentation rate （ESR）, white blood cell count （WBC） and platelet count （PLT） were compared between the two groups, and the influencing factors for IVIG non -response rate were analyzed. Results There were no statistically significant differences be- tween the two groups in gender, duration of hospitalization, ICU admission rate, the incidence of coronary artery abnormalities and coronary artery aneurysms, albumin, total bilirubin, C - reactive protein, ESR, WBC and PLT （P 〉 0. 05 ） . The differ- ence between the two groups in age, pre -treatment duration of fever, IVIG non -response rate, ALT, AST and GGT, were statistically significant （ P 〈 0.05 ） . Multivariate logistic regression analysis showed that elevated total bilirubin and hypoproteine- mia on admission were the risk factors for IVIG resistance. Conclusion Abnormal liver function is frequently found in patients with acute KD, and it may be the risk factors of IVIG resistance. Hypoproteinemia and elevated total bilirubin are the risk factors for IVIG resistance.

关 键 词：黏膜皮肤淋巴结综合征 肝功能损害 免疫球蛋白 

分 类 号：R725.512.4[医药卫生—儿科]