英夫利昔单抗治疗丙种球蛋白初治无反应型川崎病的临床疗效观察  

Clinical efficacy of infliximab in the treatment of immune globulin unresponsive Kawasaki disease

作　　者：渠宁[1] 陈莹[1] 董旭 王秋宁 Qu Ning;Chen Ying;Dong Xu;Wang Qiuning(Department of Pediatrics,Jinzhou Central Hospital,Jinzhou 121000,China;Department of Pharmacology,Jinzhou Medical University,Jinzhou 121000,China)

机构地区：[1]锦州市中心医院儿科,锦州121000 [2]锦州医科大学药理学教研室,锦州121000

出　　处：《广西医科大学学报》2022年第3期469-474,共6页Journal of Guangxi Medical University

基　　金：辽宁省自然科学基金资助项目(No.20170540358)。

摘　　要：目的:观察英夫利昔单抗(IFX)在治疗丙种球蛋白(IVIG)初治无反应型川崎病(KD)的临床疗效及不良反应。方法:选取2017年9月至2020年9月就诊于本院儿科的IVIG初治无反应型KD患儿共98例,按随机数字表法将患儿分为对照组和观察组。对照组50例予第2次IVIG冲击治疗,观察组48例予IFX治疗,比较两组患儿治疗前、后的C-反应蛋白(CRP)、白介素(IL-6)、白介素12(IL-12)、白细胞(WBC)、肿瘤坏死因子-α(TNF-α)、血小板(PLT)水平,损伤冠状动脉恢复情况以及相关临床指标和药物不良反应情况。结果:治疗后观察组患儿TNF-α、IL-6、IL-12、PLT、CRP和WBC的水平低于对照组(均P<0.05);观察组患儿冠状动脉中度扩张发生率2.08%低于对照组的26.00%(P<0.05),而治疗后冠状动脉扩张恢复正常的比例比较,差异无统计学意义(P>0.05);观察组的有效率高于对照组(P<0.05),两组患儿不良反应发生率比较,差异无统计学意义(P>0.05)。结论:应用IFX治疗IVIG初治无反应型KD患儿,可有效地降低炎性反应,缩短退热时间、皮疹消退时间、黏膜充血时间及淋巴结缩小时间,且无严重不良反应,具有较高的安全性。Objective:To investigate the clinical efficacy and adverse effects of infliximab in the treatment of Kawasaki disease unresponsive to initial treatment with intravenous immune globulin(IVIG).Methods:A total of98 children with IVIG unresponsive Kawasaki disease admitted to our pediatric department from September 2017to September 2020 were enrolled,and randomly divided into a control group and an observation group.50 patients in the control group were treated with a second IVIG,and 48 patients in the observation group were treated with infliximab.The levels of C-reactive protein(CRP),interleukin-6(IL-6),interleukin-12(IL-12),neutrophil,tumor necrosis factor-α(TNF-α) and platelet,recovery of pericardial effusion and damaged coronary artery,as well as related clinical indicators and adverse reactions were compared between the two groups before and after treatment.Results:The levels of TNF-α,IL-6,IL-12,platelet(PLT),CRP and white blood cell(WBC) in the observation group were lower than those in the control group after treatment(P<0.05).The incidence of moderate coronary artery dilatation in the observation group was 2.08%,which was lower than that in the control group(26.00%),and the efficacy rate was higher in the observation group(P<0.05).The differences were not statistically significant when comparing the percentage of coronary artery dilatation returning to normal and the incidence of adverse reactions between the two groups(P>0.05).Conclusion:The application of infliximab in the treatment of children with Kawasaki disease who were unresponsive to initial IVIG treatment can effectively reduce the inflammatory response,shorten the time of fever reduction,rash resolution,mucosal congestion and lymph node reduction without serious adverse effects,and has a high safety.

关 键 词：IVIG初治无反应 英夫利昔单抗 儿童 川崎病 

分 类 号：R725.4[医药卫生—儿科]