静脉注射人免疫球蛋白治疗对川崎病患者冠状动脉病变发生的影响  

Effect of Intravenous Infusion of Human Immunoglobulin on Coronary Artery Lesions in Children with Kawasaki Disease

作　　者：李丹 吕兴 LI Dan;LV Xing(Dongguan Maternal and Child Health Hospital,Dongguan,Guangdong 523057,China)

机构地区：[1]东莞市妇幼保健院,广东东莞523057

出　　处：《岭南心血管病杂志》2024年第4期380-385,共6页South China Journal of Cardiovascular Diseases

摘　　要：目的探讨静脉注射人免疫球蛋白(intravenous infusion of human immunoglobulin,IVIG)对川崎病(Kawasaki disease,KD)患儿冠状动脉(冠脉)病变发生的影响。方法选择2019年1月至2022年5月在东莞市妇幼保健院住院确诊并治疗的KD患儿,根据有无冠脉病变将患儿分为无冠脉病变组和冠脉病变组。对两组患者的发热时间、IVIG治疗时的病程时间、白细胞、血红蛋白、血小板、C反应蛋白、降钙素原、离子、肝及肾功能等临床资料进行分析。结果KD合并冠脉病变组患者血白细胞、血小板计数高于无冠脉病变组,而白蛋白、羟基酸脱氢酶浓度低于无冠脉病变组,差异均有统计学意义(P<0.05)。KD发热时间<8 d患儿的冠脉病变发生率低于发热时间>10 d的患儿,差异有统计学意义(P<0.05)。病程第5天前应用IVIG治疗患者冠脉病变发生率与病程第7天、第8天及10天后治疗患者比较,差异有统计学意义(P<0.05)。病程第5天及第6天应用IVIG治疗患者的冠脉病变发生率低于病程第10天后应用的患者,差异有统计学意义(P<0.05)。结论应用IVIG时间过晚,白细胞、血小板计数升高,发热时间较长是KD患儿并发冠脉病变的危险因素,而白蛋白、羟基酸脱氢酶浓度的降低也可作为KD并发冠脉病变的预测指标。热程少于8 d,病程7 d内应用IVIG治疗,可减少冠脉病变发生率。Objectives To explore the effect of intravenous infusion of human immunoglobulin(IVIG)on coronary artery lesions in children with Kawasaki disease(KD).Methods Children with KD who were hospitalized and treated in Dongguan Maternal and Child Health Hospital from January 2019 to May 2022 were selected.The children were divided into without coronary artery disease(CAD)group and with CAD group according to the presence or absence of CAD.The duration of fever,the time point of disease duration when patients received IVIG treatment,white blood cell(WBC),hemoglobin,platelets(PLT),C-reactive protein,calcitoninogen,ions,liver and renal function and other clinical data were analyzed between the two groups.Results WBC and PLT counts were higher in with CAD group than in without CAD group,while concentrations of albumin(ALB)and hydroxyacid dehydrogenase(HBDH)were lower in with CAD group than in without CAD group,and the differences were statistically significant(P<0.05).The incidence of coronary artery lesions in children with KD with fever duration of less than 8 days was lower than that of those with fever duration of more than 10 days,with statistical significance(P<0.05).The incidences of coronary artery lesions between treatment with IVIG before the 5th day of disease duration and treatment after the 7th,8th and 10th days of disease duration were statistically significant(P<0.05).The incidences of coronary lesions were lower in those treated with IVIG after 5th and 6th days than in those treated with IVIG after 10th days,and the differences were statistically significant(P<0.05).Conclusions Late application of IVIG,elevated WBC and PLT,and prolonged duration of fever are risk factors for complication of coronary artery lesions in children with KD,whereas decreased ALB and HBDH can also be used as a predictor of complication of coronary artery lesions in KD.Fever duration of less than 8 days and application of IVIG treatment within 7 days of disease duration can reduce the incidence of coronary artery lesions.

关 键 词：川崎病 冠状动脉病变 发热时间 治疗时间 静脉输注人免疫球蛋白 

分 类 号：R541.1[医药卫生—心血管疾病]