早期使用静脉注射用丙种球蛋白治疗川崎病发生耐药的危险因素分析  

Risk factors analysis of early intravenous gamma globulin treatment for drug resistance in Kawasaki disease

作　　者：刘蕾 宋晓翔[1] 鱼敏逸 封其华[1] LIU Lei;SONG Xiaoxiang;YU Minyi;FENG Qihua(Department of Rheumatology and Immunology,Soochow University Affiliated Children's Hospital,Suzhou,Jiangsu 215000,China)

机构地区：[1]苏州大学附属儿童医院风湿免疫科,江苏苏州215000

出　　处：《安徽医药》2023年第5期1022-1026,共5页Anhui Medical and Pharmaceutical Journal

基　　金：苏州市“科教兴卫”青年科技项目(KJXW2019019)。

摘　　要：目的 寻找本地区川崎病(Kawasaki disease,KD)病人早期使用静脉注射用丙种球蛋白(intravenous immunoglobulin,IVIG)发生耐药的危险因素。方法 对2017年1月至2021年6月在苏州大学附属儿童医院住院治疗并且在发热病程小于5 d时使用IVIG的川崎病病人进行回顾性分析。对IVIG敏感组、IVIG抵抗组病人流行病学资料、临床特征、实验室指标等进行危险因素分析。结果 共有122例符合条件的川崎病病人纳入研究,23例为IVIG抵抗,占18.85%。IVIG抵抗组与IVIG敏感组病人之间性别、年龄均差异无统计学意义。IVIG抵抗组病人急性期及随访半年后冠状动脉损害(coronary artery lesions,CALs)发生率与IVIG敏感组相比差异无统计学意义。IVIG抵抗组病人治疗前中性粒细胞百分比(N)、C反应蛋白(CRP)、血清总胆红素(TB)[(24.44±23.07)μmol/L比(9.89±8.17)μmol/L]水平显著高于IVIG敏感组(P<0.05),血小板计数(PLT)[(271.17±62.08)×10^(9)/L比(358.94±88.70)×10^(9)/L]、血钠(Na^(+))水平显著低于IVIG敏感组(P<0.05);多因素logistic回归分析显示:PLT及TB与川崎病病人发生IVIG抵抗显著相关(P<0.05)。结论 PLT及TB可作为预测川崎病病人于发热病程小于5 d时使用IVIG发生抵抗的重要指标。Objective To investigate the risk factors of intravenous immunoglobulin(IVIG)resistance in patients with Kawasaki disease(KD)in this region.Methods A retrospective analysis was performed for KD patients who were hospitalized in Children's Hospital of Soochow University from January 2017 to June 2021 and received IVIG when the fever course was less than 5 days.The epidemiological data,clinical characteristics and laboratory indexes of patients in IVIG-responsive group and IVIG-resistance group were analyzed.Results A total of 122 eligible patients with KD were enrolled in the study,IVIG resistance was noted in 23 patients(18.85%).There was no statistical significance in gender and age between the IVIG-responsive and IVIG-resistant group.The incidence of coronary artery lesions(CALs)was not statistical difference between the IVIG-resistant group and the IVIG-responsive group during the acute phase and after six months of follow-up.The percentage of neutrophils(N),C-reactive protein(CRP),serum bilirubin(TB)[(24.44±23.07)μmol/L vs.(9.89±8.17)μmol/L]in IVIG-resistant patients before treatment were significantly higher than those in the IVIG-responsive group(P<0.05),and platelet count(PLT)[(271.17±62.08)×10^(9)/L vs.(358.94±88.70)×10^(9)/L]and serum sodium(Na^(+))before treatment were significantly lower than those in the IVIG-responsive group(P<0.05).Multivariate Logistic regression analysis showed that TB and PLT were significantly related to IVIG resistance in patients with KD(P<0.05).Conclusion PLT and TB can be used as important indicators to predict the resistance of IVIG in patients with KD when the fever course was less than 5 days.

关 键 词：川崎病 抗药性 早期治疗 静脉注射用丙种球蛋白抵抗 危险因素 冠状动脉损害 

分 类 号：R725.4[医药卫生—儿科]