英夫利昔单抗治疗川崎病的回顾性分析  

Retrospective analysis of infliximab in the treatment of Kawasaki disease

作　　者：谢丽萍 赵璐 储晨 何岚 梁雪村 孙淑娜 赵趣鸣 王凤 曹银银 林怡翔 曾子倩 吴琳 黄国英 刘芳 Xie Liping;Zhao Lu;Chu Chen;He Lan;Liang Xuecun;Sun Shuna;Zhao Quming;Wang Feng;Cao Yinyin;Lin Yixiang;Zeng Ziqian;Wu Lin;Huang Guoying;Liu Fang(Heart Center,Children′s Hospital of Fudan University,National Children′s Medical Center,Shanghai 201102,China)

机构地区：[1]国家儿童医学中心复旦大学附属儿科医院心血管中心,上海201102

出　　处：《中华儿科杂志》2022年第1期14-19,共6页Chinese Journal of Pediatrics

基　　金：国家自然科学基金(82070513);上海市自然科学基金(20ZR1408500);上海市科委医学引导类(中、西医)科技支撑项目(18411965700);中国医学科学院创新单元(2018RU002)。

摘　　要：目的探讨英夫利昔单抗(IFX)治疗川崎病的有效性和安全性。方法回顾性研究。选择2014年1月至2021年4月复旦大学附属儿科医院收治的68例有IFX应用史的川崎病患儿作为研究对象,总结IFX应用指征、应用前后实验室指标变化、IFX敏感率、药物不良反应与并发症以及冠状动脉瘤(CAA)的转归。组间比较采用t检验、秩和检验或χ^(2)检验。结果68例川崎病患儿中男52例(76%)、女16例(24%),发病年龄2.1(0.5,3.8)岁。IFX应用指征为:35例(51%)对静脉注射丙种球蛋白(IVIG)或激素等治疗无应答患儿,其中28例(80%)在IFX应用前已并发CAA;32例(47%)CAA持续进展患儿;1例持续关节炎患儿。IFX均用于挽救治疗[发病至IFX应用时间为21(15,30)d],二线、三线、四线及以上治疗分别占29%(20/68)、29%(20/68)、41%(28/68)。IFX治疗后C反应蛋白[8(4,15)比16(8,43)mg/L,Z=-3.38,P=0.001]、血清淀粉样蛋白A[17(10,42)比88(11,327)mg/L,Z=-2.36,P=0.018]及中性粒细胞比例(0.39±0.20比0.49±0.21,t=2.63,P=0.010)均明显下降。14例(21%)对IFX不敏感,另外的挽救治疗主要为激素及环磷酰胺。IFX不敏感组与敏感组相比,在性别、IFX应用年龄、发病至IFX应用时间、IFX应用前冠状动脉最大Z值、是否合并体动脉瘤方面差异均无统计学意义(均P>0.05)。IFX治疗后11例(16%)出现感染,包括呼吸道、消化道、泌尿道、皮肤和口腔感染,1例在IFX应用2个月后发生卡介苗不良反应,均顺利治愈。68例患儿中1例因CAA破裂死亡,6例失访,余61例患儿随访6(4,15)个月,7例在IFX应用前后均未并发CAA。54例IFX应用前已并发CAA,末次随访时23例(43%)出现CAA回缩,其中10例冠状动脉内径恢复正常。结论IFX对IVIG或激素治疗无应答及CAA持续进展的川崎病患儿是一种有效且安全的选择。Objective To investigate the efficacy and safety of infliximab(IFX)therapy for children with Kawasaki disease.Methods Sixty-eight children with Kawasaki disease who received IFX therapy in Children′s Hospital of Fudan University from January 2014 to April 2021 were enrolled.The indications for IFX administration,changes in laboratory parameters before and after IFX administration,response rate,drug adverse events and complications and outcomes of coronary artery aneurysms(CAA)were retrospectively analyzed.Comparisons between groups were performed with unpaired Student t test or Mann-Whitney U test or chi-square test.Results Among 68 children with Kawasaki disease,52(76%)were males and 16(24%)were females.The age of onset was 2.1(0.5,3.8)years.IFX was administered to:(1)35 children(51%)with persistent fever who did not respond to intravenous immunoglobulin(IVIG)or steroids,28 of the 35 children(80%)developed CAA before IFX therapy;(2)32 children(47%)with continuous progression of CAA;(3)1 child with persistent arthritis.In all cases,IFX was administered as an additional treatment(the time from the onset of illness to IFX therapy was 21(15,30)days)which consisted of second line therapy in 20(29%),third line therapy in 20(29%),and fourth(or more)line therapy in 28(41%).C-reactive protein(8(4,15)vs.16(8,43)mg/L,Z=-3.38,P=0.001),serum amyloid protein A(17(10,42)vs.88(11,327)mg/L,Z=-2.36,P=0.018)and the percentage of neutrophils(0.39±0.20 vs.0.49±0.21,t=2.63,P=0.010)decreased significantly after IFX administration.Fourteen children(21%)did not respond to IFX and received additional therapies mainly including steroids and cyclophosphamide.There was no significant difference in gender,age at IFX administration,time from the onset of illness to IFX administration,the maximum coronary Z value before IFX administration,and the incidence of systemic aneurysms between IFX-sensitive group and IFX-resistant group(all P>0.05).Infections occurred in 11 cases(16%)after IFX administration,including respiratory tract,digestive t

关 键 词：粘膜皮肤淋巴结综合征 冠状动脉瘤 回顾性研究 

分 类 号：R725.4[医药卫生—儿科]