标危川崎病患儿对两种大剂量丙种球蛋白方案疗效分析及外周血淋巴细胞与T细胞亚群相关性分析

发布时间：2018-09-10 13:27

【摘要】：第一部分标危川崎病患儿对两种大剂量丙种球蛋白方案疗效分析目的通过对筛选后的川崎病临床资料进行回顾分析，探讨两种大剂量静脉注射丙种球蛋白（intravenous immune globulin IVIG）方案对标危川崎病（Kawasaki diseaseKD）患儿的临床疗效及优选方案。方法94例KD标危患儿[为KD未合并冠状动脉病变（Coronary artery lesionsCALs）高危因素患儿，入院时小林评分（Kobayashi risk score）7分]，按IVIG给药剂量分为A组（1g/kg单次使用，36例）及B组（1g/kg连用两天，58例），对两种方案疗效进行回顾性对比分析。观察两组患儿住院天数，热退时间，及粘膜充血、皮疹、手足肿胀及颈淋巴结肿大消退时间；检测外周血白细胞计数（WBC）、血小板计数（PLT）、血红蛋白计数（Hb）、C-反应蛋白（CRP）、红细胞沉降率（ESR）恢复情况以及CALs随访分析；并对两组组内、组间及治疗前后结果进行比较分析。结果两组治疗方案在住院天数、急性期症状消退时间均有显著疗效，组间比较无统计学差异（P0.05）；两组WBC、CRP、ESR指标与治疗前比较均明显降低（P0.01），PLT计数较治疗前显著升高（P0.05），Hb计数变化不明显，差异无统计学意义（P0.05）；治疗后A组CALs发生率为16.67%（6/36），B组CALs发生率为18.97%（11/58），在10周内随访结果均恢复正常，两组比较差异亦无明显意义（P0.05），其中仅A组1例为IVIG耐药病例。结论对KD未合并CALs高危因素患儿而言，IVIG1g/kg单次使用在急性期症状消退、炎性指标恢复及预防CALs方面与1g/kg连用两天比较具有同样的近期及远期疗效，可推荐为标危KD的优选治疗方案。第二部分川崎病外周血淋巴细胞与T细胞亚群的相关性分析目的探讨川崎病（Kawasaki disease KD）患儿外周血淋巴细胞与T细胞亚群的相关性，为川崎病免疫学机制研究提供参考。方法47例川崎病患儿及对照组51例支气管肺炎患儿，，入院后同时采集外周血检测淋巴细胞计数、比例，以及T细胞亚群包括CD3+、CD4+、CD8+、CD4+/CD8+及CD56+CD16+百分比。分别对各项结果进行相关性分析。结果川崎病组外周血淋巴细胞计数及比例与CD56+CD16+均呈负相关（r=-0.369，P0.05vs r=-0.316，P0.05）；川崎病组及对照组淋巴细胞比例与CD3+（r=0.384，P0.01vs r=0.283，P0.05）及CD4+（r=0.511，P0.01vs r=0.326，P0.05）呈正相关。两组淋巴细胞计数及比例与其他T细胞亚群（CD8+及CD4+/CD8+）均无相关性（P0.05）。结论外周血淋巴细胞与T细胞亚群的相关性结果提示T淋巴细胞参与川崎病急性期的免疫反应机制，对川崎病发病机制研究可能有辅助意义。
[Abstract]:The first part: efficacy analysis of two high dose gamma globulin regimens in children with Kawasaki disease objective to retrospectively analyze the clinical data of Kawasaki disease after screening. To investigate the clinical efficacy and optimal selection of two high dose intravenous immunoglobulin (intravenous immune globulin IVIG) regimens in children with (Kawasaki diseaseKD) with risk of Kawasaki disease. Methods 94 children with KD risk [KD without coronary artery disease complicated with (Coronary artery lesionsCALs) risk factors] were included in this study. On admission, Xiao Lin score (Kobayashi risk score) 7) was divided into two groups according to the dosage of IVIG: group A (36 cases of 1g/kg) and group B (58 cases of 1g/kg for two days). The days of hospitalization, the time of heat withdrawal, the time of mucosal congestion, rash, swelling of hand and foot and the time of neck lymph node swelling were observed. Peripheral blood white blood cell count (WBC), platelet count (PLT), hemoglobin count (Hb) C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) recovery and CALs follow-up analysis were performed and the results were compared between the two groups and before and after treatment. Results there was significant curative effect between the two groups in the days of hospitalization and the time of symptom regression in the acute phase, but there was no statistical difference between the two groups (P0.05). Compared with before treatment, the WBC,CRP,ESR counts of the two groups were significantly decreased (P0.01) significantly higher than that before treatment (P0.05), there was no significant difference between the two groups (P0.05). After treatment, the incidence of CALs in group A was 16.67% (6 / 36). The incidence of CALs in group B was 18.97% (11 / 58). The results of follow-up within 10 weeks all returned to normal, and there was no significant difference between the two groups (P0.05). Only one case in group A was IVIG resistant. Conclusion single use of IVIG 1g / kg in children with KD without CALs risk factors has the same short-term and long-term effects as that of 1g/kg for two days in the recovery of acute symptoms, the recovery of inflammatory indexes and the prevention of CALs. It can be recommended as an optimal treatment regimen for KD. The second part: correlation analysis between peripheral blood lymphocytes and T cell subsets in children with Kawasaki disease objective to explore the correlation between peripheral blood lymphocytes and T cell subsets in children with Kawasaki disease (Kawasaki disease KD) and to provide reference for the study of immunological mechanism of Kawasaki disease. Methods 47 children with Kawasaki disease and 51 patients with bronchopneumonia were included in the study. Peripheral blood lymphocytes were collected at the same time and T cell subsets including CD3 CD 4, CD 8, CD 4 / CD 8 and the percentage of CD56 CD16 were collected at the same time. Correlation analysis of each result was carried out respectively. Results in Kawasaki disease group, the number and proportion of peripheral blood lymphocytes were negatively correlated with CD56 CD16 (r = 0.369p 0.05 vs r = 0.316P 0.05), and positively correlated with CD3 (r = 0.384p 0.01 vs r = 0.283P 0.05) and CD4 (r = 0.511P 0.01 vs r = 0.326P 0.05) in Kawasaki disease group and control group. There was no correlation between lymphocyte count and percentage of T cell subsets (CD8 and CD4 / CD8) in both groups (P0.05). Conclusion the correlation between peripheral blood lymphocytes and T cell subsets suggests that T lymphocytes are involved in the immune response mechanism of Kawasaki disease and may be helpful to the study of the pathogenesis of Kawasaki disease.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R725.4

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