耐药型川崎病不同治疗方案的比较  

Comparison of different treatment regiments in resistant Kawasaki disease

作　　者：郭翼红[1] 俞海国[1] 张雅媛[1] 黄娜[1] 马乐 Guo Yihong;Yu Haiguo;Zhang Yayuan;Huang Na;Ma Le(Rheumatology and Immunology Department,Children's Hospital of Nanjing Medical University,Jiangsu 210008,China)

机构地区：[1]南京医科大学附属儿童医院风湿免疫科,210008

出　　处：《中华风湿病学杂志》2020年第7期459-462,共4页Chinese Journal of Rheumatology

基　　金：国家自然科学基金青年科学基金(81800438)。

摘　　要：目的探讨丙种球蛋白无反应型川崎病(耐药型川崎病)再次治疗时不同治疗方案的差异,为临床治疗的选择提供依据。方法收集2017年7月至2019年6月在我科住院治疗的耐药型川崎病共患者49例。分别予丙种球蛋白加激素及英夫利西单抗治疗,后期随访冠状动脉病变的发生情况。分别采用秩和检验、χ^2检验/Fisher确切概率法进行统计学分析。结果耐药型川崎病予英夫利西单抗治疗与丙球加激素治疗相较,16例给予英夫利西单抗组5 mg/kg治疗,热退,炎症指标好转,无再次耐药发生;33例予2次丙种球蛋白加激素治疗组,24例好转,9例无反应,后予英夫利西单抗治疗,其中6例好转,3例加环孢素后热退,炎症指标好转。随访3~24个月,丙种球蛋白加激素治疗组发生冠状动脉病变36%(12/33),英夫利西单抗组为25%(4/16),2组比较差异无统计学意义(χ^2=0.633,P=0.426)。英夫利西单抗组和丙种球蛋白加激素治疗组冠状动脉中度扩张发生率分别为0和24%(8/33),差异有统计学意义(P=0.021)。丙种球蛋白加激素治疗组冠状动脉病变4例恢复至正常,英夫利西单抗组冠状动脉病变3例恢复至正常,目前仍在治疗随访中。结论耐药型川崎病再次治疗可以优选英夫利西单抗。Objective To investigate the different effects of different treatment regimens in resistant Kawasaki disease(KD)and to provide evidence for clinical treatment.Methods Forty-nine inpatient children with resistant KD from July 2017 to June 2019 in Children's Hospital of Nanjing Medical University were enrolled into this study.Treatment and follow-up were still in progress.Rank sum test andχ^2/Fisher test were used for statisic.Results The incidence of resistance in infliximab group was significantly lower than that of intravenous immunoglobulin(IVIG)retreated group(P<0.05).Sixteen cases were treated with 5 mg/kg infliximab(IFX),and 33 cases received methylprednisolone and an additional dose of IVIG.Nine cases who were resistant to IVIG and methylprednisolone were treated with IFX,6 patients responded to IFX,3 of them were treated with cyclosporine.Coronary artery changes were followed up.Coronary artery lesions(CALs)were improved in the IFX group,CALs occurred in 12(36%)patients received IVIG and methylprednisolone,4 of them were improved(χ^2=0.633,P=0.426).Patients were followed up for 3-24 months,the incidence of CALs persistence was statistically significantly different between the two groups(0 vs 24%,P=0.021).Conclusion IFX might be an effective and tolerable treatment for resistant KD.

关 键 词：皮肤黏膜淋巴结综合征 耐药型 英夫利西单抗 

分 类 号：R725.4[医药卫生—儿科]