摘要
目的:探讨首次静脉丙种球蛋白(IVIG)治疗无反应性川崎病的相关因素及再治疗结果。方法:分析总结2005年3月～2009年2月在本院收治的川崎病患儿的病历资料。IVIG无反应性定义为首次IVIG治疗48小时后体温仍超过38℃。初治有效者为敏感组,无效者为无反应组,对两组患儿临床表现及实验室数据进行统计分析。结果:281例符合川崎病的诊断标准患儿,急性期应用IVIG治疗,其中12例对首次IVIG无反应,发生率4.27%,与敏感组相比,该组全血白细胞计数(WBC)、中性粒细胞百分比(N%)、血沉(ESR)明显升高(P<0.05),冠脉病变(CAL)发生率增高(P<0.01);再治疗选择中,无反应组12例全部接受IVIG2g/(kg.d)1次再次治疗,有效10例,占83.3%,2例对IVIG仍无反应,予糖皮质激素治疗后好转。结论:本组病例中IVIG无反应川崎病发生率约4.27%,其特点为WBC、N%、ESR较高,冠脉病变发生率高。对初次IVIG无效患儿可再次使用静脉丙球治疗,若仍无效可予糖皮质激素治疗。
Objective：To evaluate the risk factors of children with refractory Kawasaki disease（KD）and report the outcome of retreatment.Methods：Clinical data of all children with KD in Nanjing Children’s Hospital were summarized from 2005 through 2009.Refractory KD was defined as those who remained febrile with a temperature beyond 38℃,48 hours after initial intravenous immunoglobulin treatment（IVIG）.Results：A totle of 281 patients were included as study subjects.They received initial IVIG therapy in acute phase,and 12 did not respond to the initial IVIG therapy with an incidence of 4.27%（12/281）.We found that ESR,WBC,percentage of neutrophil were risk factors for refractory KD（P〈0.05）.They had a higher prevalence of CAL at the acute phase（P〈0.01）.Children with refractory KD were retreated with a second IVIG of 2 g/kg in 12 patients with 10 responding（83.3%）.Steroid was used in 2 children with both responding.Conclusion：The incidence of refractory KD in Nanjing Children’s Hospital is 4.27%.ESR,WBC and percentage of neutrophil are risk factors for refractory KD.Refractory KD has a higher prevalence of CAL at the acute phase.Retreated of children with refractory KD with a 2 g/Kg IVIG is probably more effective.For those who remain febrile after two doses of IVIG can pulse methylprednisolone.
出处
《中国免疫学杂志》
CAS
CSCD
北大核心
2010年第11期1036-1038,共3页
Chinese Journal of Immunology
关键词
川崎病
静脉丙种球蛋白
无反应性
Kawasaki disease
Intravenous immunoglobuhn
Nonresponsiveness
