川崎病患儿丙种球蛋白治疗不敏感影响因素及其与铁蛋白、丙氨酸氨基转移酶、天冬氨酸氨基转移酶、血沉水平的关系  

Influencing factors of gamma globulin insensitivity in children with Kawasaki disease and their relation to levels of ferritin,ALT,AST and erythrocyte deposition rate

作　　者：夏玲 朱芳艮 刘晓玲[1] Xia Ling;Zhu Fang-gen;Liu Xiao-ling(Department of Pediatrics,Anqing First People’s Hospital Affiliated to Anhui Medical University,Anqing 246003,China)

机构地区：[1]安徽医科大学附属安庆市第一人民医院儿科,安庆246003

出　　处：《中国药物应用与监测》2024年第6期755-759,共5页Chinese Journal of Drug Application and Monitoring

基　　金：安徽省高等学校科学研究项目(2022AH050748)

摘　　要：目的探讨川崎病患儿静脉注射丙种球蛋白(IVIG)治疗不敏感的影响因素及其与血清铁蛋白、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)水平、血沉的关系。方法回顾分析2020年7月至2024年1月安徽医科大学附属安庆市第一人民医院收治的20例IVIG治疗不敏感的川崎病患儿临床资料(作为不敏感组)以及同期收治的55例IVIG治疗敏感患儿临床资料(作为敏感组),分析川崎病患儿IVIG治疗不敏感的影响因素,比较两组血清铁蛋白、ALT、AST、血沉。结果发热持续时间较长(OR=1.605,95%CI:1.033~2.494)、合并冠状动脉损害(OR=1.855,95%CI:1.024~3.360)、外周血中性粒细胞比例较高(OR=1.642,95%CI:1.024~2.634)、外周血血小板水平较低(OR=1.781,95%CI:1.015~1.196)均为川崎病患儿IVIG治疗不敏感的独立危险因素(均P<0.05)。不敏感组血清铁蛋白水平及血沉[分别为(210.62±34.73)ng·mL^(-1),(22.41±4.62)mm·h^(-1)]均高于敏感组[分别为(177.88±28.74)ng·mL^(-1),(16.41±3.55)mm·h^(-1)](t=4.123、5.957,均P<0.05),两组血清ALT、AST水平[分别为(43.97±4.77)U·L^(-1),(37.89±4.32)U·L^(-1)vs(44.22±4.61)U·L^(-1),(38.16±5.15)U·L^(-1)]比较,差异均无统计学意义(t=0.206、0.209,均P>0.05)。结论川崎病患儿IVIG治疗不敏感的独立危险因素包括发热持续时间较长、合并冠状动脉损害、外周血中性粒细胞比例较高、外周血血小板水平较低。川崎病患儿IVIG治疗不敏感可对血清铁蛋白水平及血沉产生影响,但对血清ALT、AST水平的影响不明显。Objective To investigate the influence factors of insensitivity to intravenous gammaglobulin(IVIG)treatment in children with Kawasaki disease and their relation to serum levels of serum ferritin,alanine aminotransferase(ALT),aspartate aminotransferase(AST)and erythrocyte deposition rate.Methods The clinical data of 20 children with Kawasaki disease admitted to Anqing First People’s Hospital from July 2020 to January 2024 who were insensitive to IVIG and that of other 55 children with Kawasaki disease treated in the same hospital and the same period who were sensitive to IVIG were collected retrospectively.The former 20 children were included in the insensitive group and the latter 55 children were included in the sensitive group.The influencing factors of IVIG insensitivity in children with Kawasaki disease were analyzed,and the levels of serum ferritin,ALT,AST and erythrocyte deposition rate were compared between the two groups.Results The long duration of fever(OR=1.605,95%CI:1.033-2.494),coronary artery damage(OR=1.855,95%CI:1.024-3.360),high proportion of peripheral neutrophils(OR=1.642,95%CI:1.024-2.634)and low level of peripheral blood platelet(PLT)(CI=1.781,95%CI:1.015-1.196)were independent risk factors for insensitivity to intravenous gamma globulin therapy in children with Kawasaki disease(P<0.05).The level of serum ferritin and erythrocyte deposition rate((210.62±34.73)ng·mL^(-1)and(22.41±4.62)mm·h^(-1)respectively)in the insensitive group were higher than those in the sensitive group((177.88±28.74)ng·mL^(-1)and(16.41±3.55)mm·h^(-1)respectively)(t=4.123,5.957,both P<0.05),but there was no significant difference in levels of serum ALT and AST between the two groups((43.97±4.77)U·L^(-1),(37.89±4.32)U·L^(-1)vs(44.22±4.61)U·L^(-1),(38.16±5.15)U·L^(-1)respectively)(t=4.123,5.957,both P>0.05).Conclusion Independent risk factors for insensitivity to IVIG therapy in children with Kawasaki disease include longer duration of fever,coronary artery damage,higher peripheral blood neutrophils ratio

关 键 词：川崎病 丙种球蛋白 影响因素 铁蛋白 丙氨酸氨基转移酶 天冬氨酸氨基转移酶 血沉 

分 类 号：R725.4[医药卫生—儿科]