川崎病患儿对静脉注射免疫球蛋白治疗反应的病例对照研究  

A case control study of response to treatment in children with Kawasaki disease on intravenous immunoglobulin

作　　者：王从军[1] 雷中劲[2] 

机构地区：[1]湖北省荆楚理工学院医学院儿科教研室,湖北省荆门市448000 [2]湖北省荆门市第一人民医院儿科,448000

出　　处：《实用医学杂志》2015年第16期2651-2654,共4页The Journal of Practical Medicine

基　　金：2010湖北省教育厅优秀中青年人才项目(编号:Q20104302)

摘　　要：目的:研究大剂量静脉注射丙种球蛋白(IVIG)治疗川崎病无反应的影响因素。方法:回顾分析2008年7月至2013年12月期间163例住院川崎病患儿的临床资料,根据首次对IVIG的治疗效果将患儿分为IVIG敏感型和IVIG无反应型,对比两型川崎病患儿的临床特点及实验室检查指标。结果:两组患儿在发病年龄、性别、IVIG治疗前发热时间、临床表现完全与否及血WBC、CK-MB、PLT、ESR方面差异无显著性(P>0.05)。无反应型组无菌性脓尿、颈部淋巴结肿大、冠状动脉损害发生率及外周血中性粒细胞比例、CRP、AST、ALT、总胆红素显著高于敏感型组(P<0.001),而血白蛋白、高密度脂蛋白、钠离子浓度则低于IVIG敏感型患儿(P<0.05)。结论 :无菌性脓尿、冠状动脉损害、颈部淋巴结肿大发生率及外周血中性粒细胞比例增高;血CRP、AST、ALT、总胆红素浓度增高;血浆白蛋白和钠离子浓度减少是川崎病患儿IVIG无反应的危险因素。Objective To investigate the clinical features of nonresponsive Kawasaki disease by intravenous immunoglobuhn. Methods The clinical data of 163 hospitalized patients of Kawasaki disease from June 2008 to February 2013 were analyzed retrospectively based on the response to high intravenous immunoglobulin （IVIG） therapy. All patients were divided into responsive group and nonresponsive group. The clinical characteristics and biochemical index were compared in two groups. Results The nonresponsive group had more frequently experienced in coronary artery lesion, cervical lymph node enlargement, sterile pyuria and higher levels of neutrophils, CRP, AST, ALT, TBIL and lower levels of albumin, high density lipoprotein, serum sodium concentration than the responsive group （P 〈 0.05）. No differences was found in the age, sex, duration of fever at initial treatment, clinical manifestations complete or incomplete and WBC, CK-MB, PLT, ESR between the two groups （P 〉 0.05）. Conclusion It might be useful in predicting nonresponse to IVIG therapy in children with Kawasaki disease in more frequently experienced coronary artery lesion, cervical lymph node enlargement, sterile pyuria and higher levels of neutrophils, CRP, AST, ALT, LDH, TBIL and lower levels of albumin, high density lipoprotein, serum sodium concentration.

关 键 词：川崎病 免疫丙种球蛋白 无反应 

分 类 号：R725.4[医药卫生—儿科]