英夫利昔单抗治疗川崎病患者的疗效及其药物敏感性影响因素分析  

Analysis of factors affecting efficacy and drug sensitivity of infliximab in treatment of Kawasaki disease

作　　者：颜运利 王晓猛 袁金玉 Yan Yun-li;Wang Xiao-meng;Yuan Jin-yu(Department of Pediatrics,Dongxing District People’s Hospital,Neijiang 641000,China;Department of Pediatrics,Sichuan Maternal and Child Health Hospital,Chengdu 610045,China)

机构地区：[1]内江市东兴区人民医院儿科,内江641000 [2]四川省妇幼保健院儿科,成都610045

出　　处：《中国药物应用与监测》2025年第1期149-152,共4页Chinese Journal of Drug Application and Monitoring

摘　　要：目的探究英夫利昔单抗(infliximab,IFX)治疗川崎病(Kawasaki disease,KD)的疗效,分析其药物敏感性影响因素。方法纳入2017年3月至2023年3月于内江市东兴区人民医院儿科、四川省妇幼保健院儿科治疗的385例KD患儿,随机数字表法分成对照组和观察组,对照组192例患儿应用大剂量静脉丙种球蛋白进行冲击治疗,观察组193例患儿使用IFX进行治疗。比较分析两组患儿的临床疗效。根据IFX药物敏感性将观察组患儿分为敏感组(n=158例)与不敏感组(n=35例),采用多因素Logistic回归分析对IFX治疗KD患儿的药物敏感性的影响因素进行分析。结果治疗5 d后,观察组总有效率89.12%(172/193)较对照组73.08%(140/192)更高,差异有统计学意义(P<0.05)。治疗期间总不良反应发生率观察组18.65%(36/193)和对照组20.31%(39/192),差异无统计学意义(χ^(2)=0.080,P=0.778)。观察组患儿的皮疹消退时长、发热时长、结膜充血时长和淋巴结缩小时长[分别为(2.36±0.68)d、(1.98±0.51)d、(3.19±0.67)d、(2.98±0.67)d]均小于对照组[(3.70±0.70)d、(2.83±0.48)d、(4.37±0.64)d、(3.72±0.46)d],差异有统计学意义(t=19.051、t=19.051、t=19.051、t=19.051,均P<0.01)。药物敏感组的白细胞介素6(IL-6)水平和中性粒细胞比值[分别是(51.38±5.66)ng·mL^(-1)、(52.13±10.81)%]均低于药物不敏感组[分别是(56.41±6.07)ng·mL^(-1)、(58.75±9.23)%](χ^(2)=4.695、3.360,P<0.001)。多因素Logistic回归分析结果显示,随着IL-6水平和中性粒细胞比值增加一个单位,IFX治疗KD患儿不敏感的风险分别增加1.141(95%CI:1.033~1.206,P<0.001)、1.611倍(95%CI:1.216~2.059,P<0.001)。结论IFX治疗KD患儿具有显著疗效,不良反应发生率也较低;此外,患儿体内IL-6水平和中性粒细胞比值与IFX治疗KD患儿的药物敏感性密切相关,可作为该病临床治疗的预后指标。Objective To explore the efficacy of infliximab(IFX)in the treatment of Kawasaki disease(KD)and analyze the influencing factors of drug sensitivity.Methods A total of 385 KD invalids treated in Dongxing District People’s Hospital and Sichuan Maternal and Child Health Hospital from March 2017 to March 2023 were selected as the research subjects and divided into two groups according to the treatment methods.The patients in the control group(n=192)received shock treatment with highdose intravenous gamma globulin(IVIG)while those in the observation group(n=193)were treated with IFX.The clinical efficacy was compared between the two groups.According to IFX drug sensitivity,the children were further divided into the sensitive group(n=158)and insensitive group(n=35).Multivariate Logistic regression analysis was used to analyze the influencing factors of drug insensitivity in children with KD treated by IFX.Results Following a five-day treatment,the observation group achieved a total effective rate of 89.12%,surpassing the control group’s rate of 73.08%.This disparity between the two groups was found to be statistically obvious(P<0.05).Throughout the treatment duration,the observation group reported an incidence of overall adverse reactions at 18.65%(36/193),whereas the control group experienced a rate of 20.31%(39/192).However,this difference in adverse reaction rates failed to reach statistical significance(χ^(2)=0.080,P=0.778).The rash subsidence time,fever time,conjunctival congestion time and lymph node shrinkage time of the patients in the observation group were(2.36±0.68)d,(1.98±0.51)d,(3.19±0.67)d,and(2.98±0.67)d respectively,all of which were shorter than those of the control group((3.70±0.70)d,(2.83±0.48)d,(4.37±0.64)d,(3.72±0.46)d)(t=19.051,19.051,19.051,19.051,all P<0.05).The levels of IL-6 and neutrophil ratio in the drug-sensitive group((51.38±5.66)ng·mL^(-1),(52.13±10.81)%)were lower than those in the drug-insensitive group((56.41±6.07)ng·mL^(-1),(58.75±9.23)%)(t=4.695,3.360,P<0.001).Mea

关 键 词：英夫利昔单抗 川崎病 丙种球蛋白 临床疗效 敏感性 

分 类 号：R725.4[医药卫生—儿科]