静脉丙种球蛋白无反应性川崎病的危险因素分析

中国临床药理学与治疗学 ›› 2011, Vol. 16 ›› Issue (6): 657-660.

静脉丙种球蛋白无反应性川崎病的危险因素分析

张松跃, 张园海, 荣星, 任跃, 陈其, 项如莲

温州医学院附属第二医院小儿心血管科,温州 325027,浙江

收稿日期:2011-05-04 修回日期:2011-05-27 发布日期:2011-07-25
作者简介:张松跃,女,本科,住院医师,主要从事小儿心血管疾病研究。 Tel: 0577-88816178 E-mail: zhsy0121@sina.com

Analysis of risk factors with refractory Kawasaki disease to gamma-globulin therapy

ZHANG Song-yue, ZHANG Yuan-hai, RONG Xing, REN Yue, CHEN Qi, XIANG Ru-lian

Department of Pediatric Cardiology, Second Affiliated Hospital of Wenzhou Medical College,Wenzhou 325027,Zhejiang, China

Received:2011-05-04 Revised:2011-05-27 Published:2011-07-25

摘要/Abstract

摘要： 目的: 探讨首次静脉注射丙种球蛋白(IVIG)无反应性川崎病(KD)的发病率及相关危险因素。方法: 总结2005年1月至2010年12月温州医学院附属第二医院KD患儿的临床资料,IVIG无反应性KD定义为首次IVIG治疗无效,36 h 后体温仍超过 38.5 ℃,根据对首次大剂量IVIG有无反应分成IVIG敏感组和IVIG无反应组,比较两组的临床特点。结果: 515例KD患儿纳入研究对象,其中IVIG敏感者476例,IVIG无反应者39例,发生率为 7.57% (39/515)。Logistic回归分析发现血白细胞、血红蛋白、C反应蛋白(CRP)、血沉、ALT、白蛋白及IVIG用药方案是IVIG无反应性的独立危险因素(P<0.05)。结论: 7.57% KD患儿对初次IVIG治疗无反应。血白细胞、血红蛋白、CRP、血沉、ALT、白蛋白及IVIG用药方案是IVIG无反应的独立危险因素。

关键词: 川崎病, 丙种球蛋白, 静脉注射, 无反应, 危险因素

Abstract: AIM: To investigate the incidence and risk factors of children with refractory Kawasaki disease (KD). METHODS: Clinical data of KD patients hospitalized in the Second Affiliated Hospital of Wenzhou Medical College from January 2005 to December 2010 were summarized.Refractory KD was defined as those who remained febrile with a temperature of > 38.5 ℃ for 36 hours after initial intravenous immunoglobulin treatment. All KD patients were divided into two groups, responsiveness group and non-responsiveness group,based on their response to the first high dose IVIG therapy. RESULTS: Total 515 KD patients treated with high dose IVIG were included.The incidence of non-responsiveness to IVIG therapy is 7.57% (39/515). Logistic regression revealed that white blood cell(WBC), hemoglobin,C-reactive protein(CRP), erythrocyte sedimentation rate(ESR), alanine aminotransferase (ALT), serum albumin and IVIG dosage were independent risk factors for refractory KD(P<0.05). CONCLUSION: The incidence of refractory KD is 7.57%. WBC, hemoglobin, CRP, ESR,ALT, serum albumin and IVIG dosage can predict the occurrence of refractory KD.

Key words: Kawasaki disease, Gamma globulin, Intravenous injection, Non-responsiveness, Risk factor

中图分类号:

R543.6

张松跃, 张园海, 荣星, 任跃, 陈其, 项如莲. 静脉丙种球蛋白无反应性川崎病的危险因素分析[J]. 中国临床药理学与治疗学, 2011, 16(6): 657-660.

ZHANG Song-yue, ZHANG Yuan-hai, RONG Xing, REN Yue, CHEN Qi, XIANG Ru-lian. Analysis of risk factors with refractory Kawasaki disease to gamma-globulin therapy[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2011, 16(6): 657-660.

参考文献

[1] Durongpisitkul K, Soongswang J, Laohap rasitiporn D, et al. Immunoglobulin failure and retreatment in Kawasaki disease [J].Pediatr Cardiol, 2003, 24 (2) : 145-148.
[2] Sittiwangkul R, Pongprot Y, Silvilairat S,et al. Management and outcome of intravenous gammaglobulin-resistant Kawasaki disease [J]. Singapore Med J, 2006, 47 (9) : 780-784.
[3] Yanagawa H, Sonobe T. Changes in the diagnostic guidelines for Kawasaki disease//Yanagawa H, Nakamuru Y, Yashiro M, et al, eds. Epidemiology of Kawasaki disease: a 30-year achievement [M]. Tokyo: Shindan-To-Chiryosha, 2004: 24-32.
[4] Newburger JW,Takahashi M,Gerber MA,et al.Diagnosis,treatment,and long-term management of Kawasaki disease:a statement for health professionals from the Committee on Rheumatic Fever,Endocarditis,and Kawasaki Disease,Council on Cardiovascular Disease in the Young American Heart Association [J].Peadiatrics,2004,114(6):1708－1733.
[5] 张园海,何跃娥,项如莲,等.川崎病急性期血清对血管内皮MMP-2、MMP-9和TNF-α分泌的影响及IVIG的干预机制探讨[J].中国临床药理学与治疗学,2009,14(5):586-590.
[6] Freeman AF, Shulman ST. Refractory Kawasaki disease [J]. Pediatr Infect Dis J, 2004,23 (5):463-464 .
[7] Sano T, Kurotobi S, Matsuzaki K, et al. Prediction of non-responsiveness to standard high-dose gammaglobulin therapy in patients with acute Kawasaki disease before starting initial treatment[J]. Eur J Pediatr, 2007,166 (2):131-137.
[8] Cha S, Yoon M, Ahn Y, et al. Risk factors for failure of initial intravenous immunoglobulin treatment in Kawasaki disease[J].J Korean Med Sci,2008,23(4): 718-722.
[9] Tremoulet AH, Best BM,Song S. et al. Resistance to intravenous immunoglobulin in children with Kawasaki disease [J]. J Pediatr, 2008, 153 (1) : 117-121.
[10] 朴金花,金莲花,孙景辉,等.大剂量静脉注射丙种球蛋白无反应性川崎病的临床分析[J].临床儿科杂志,2009,27(5):480-483.
[11] Miura M, Ohki H, Tsuchihashi T, et al. Coronary risk factors in Kawasaki disease treated with additional gammaglobulin [J ]. Arch Dis Child, 2004,89 (8) : 776-780.
[12] Do YS, Kim KW, Chun JK, et al. Predicting factors for refractory kawasaki disease[J]. Korean Circ J, 2010,40(5):239-242.
[13] 杜忠东,张永兰,赵地,等.静脉丙种球蛋白无反应性川崎病的治疗及危险因素分析[J].中国实用儿科杂志,2006,21(10):738-741.
[14] 张雅嫒,钱小青,李娟,等. 丙种球蛋白无反应性川崎病相关因素及治疗探讨[J].中国免疫学杂志, 2010, 26 ( 11) : 1036-1038.