静脉注射丙种球蛋白无反应性川崎病临床分析  

Clinical analysis on Kawasaki disease non-responsive to IVIG

作　　者：夏琨[1] 尹薇[1] 王瑞耕[1] 孙东明[1] 刘玲[1] 

机构地区：[1]湖北省武汉市儿童医院心血管内科,430016

出　　处：《中国妇幼保健》2014年第10期1570-1573,共4页Maternal and Child Health Care of China

摘　　要：目的:探讨静脉注射丙种球蛋白(IVIG)无反应性川崎病(KD)的临床特征、治疗方法、冠状动脉病变(CAL)发生的危险因素及预后。方法:回顾性分析总结该院心血管内科病房2008年6月~2011年11月收治的195例川崎病患儿的病历资料。按照对首次大剂量IVIG治疗的反应性,分为敏感组及无反应组。结果:195例KD患儿中,IVIG敏感组149例,IVIG无反应组46例。合并CAL 46例,IVIG敏感组15例,发生率10.07%;IVIG无反应组31例,发生率67.39%,明显高于IVIG敏感组,差异有统计学意义(P<0.05)。IVIG无反应组中血红蛋白明显低于敏感组,差异有统计学意义(P<0.05),血小板,血沉及谷丙转氨酶明显高于敏感组,差异有统计学意义(均P<0.05)。IVIG无反应性KD患儿经追加IVIG 1 g/kg或2 g/kg或糖皮质激素治疗后,均能退热。对46例合并CAL患儿出院后随访2年,45例恢复正常,1例巨大冠状动脉瘤有缩小,IVIG敏感组与IVIG无反应组预后(修)差异无统计学意义(P>0.05)。结论:IVIG无反应性KD较IVIG敏感性KD更易发生CAL。血小板、血沉及谷丙转氨酶升高、血红蛋白降低是IVIG无反应性的危险因素。IVIG无反应组经追加IVIG(1 g/kg或2 g/kg)或糖皮质激素治疗后,CAL发生率差异无统计学意义,预后良好。Objective： To explore the clinical features, treatment methods of Kawasaki disease （KD） non -responsive to intravenous injection of gamma globulin （IVIG） and the high risk factors, prognosis of coronary artery lesions （CAL） . Methods： The clinical da- ta of 195 cases with KD treated in the hospital from June 2008 to November 2011 were analyzed retrospectively. Those cases were divided into sensitive group and non - responsive group according to the response to the first high - dose treatment with IVIG. Results： There were 149 cases in sensitive group and 46 cases in non -responsive group among 195 cases with KD. In the whole cases, 46 cases were found with CAL, including 15 cases （10. 07% ） in sensitive group and 31 cases （67.39%） in non -responsive group, and the latter ratio was statisti- cally signit^cantly higher than the former ones （P 〈 0. 05） . Hemoglobin level in non - responsive group was statistically significantly lower than that itt sensitive group （P 〈 0. 05 ） ; while platelet count, erythrocyte sedimentation rate, and alanine aminotransferase level in non - re- sponsive group were statistically significantly higher than those in sensitive group （P 〈 0. 05） . Those children with KD non - responsive to IVIG were treated by additional IVIG lg/kg, 2g/kg or glucocorticoid, all of them brought down the fever. After followed -up for 2 years, a- mong 46 cases with CAL, 45 cases returned to normal and 1 patient with giant coronary aneurysm was significantly improved, there was no statistically significant difference between sensitive group and non - responsive group. Conclusion： KD non - responsive to IVIG has the higher incidence rate of CAL compared with KD sensitive to IVIG. Higher platelet count, erythrocyte sedimentation rate, alanine aminotrans- ferase level arid lower hemoglobin level are risk factors of KD non - responsive to IVIG. After treated with additional IVIG （ 1g/kg or 2g/kg） or glucocorticoid, the incidence rate of CAL in non - response group

关 键 词：川崎病 儿童 丙种球蛋白无反应性 冠状动脉病变 危险因素 治疗 预后 

分 类 号：R725[医药卫生—儿科]