激素在静脉丙种球蛋白无反应川崎病中的应用研究
发布时间：2018-10-16 12:02
【摘要】：目的探讨激素对静脉丙种球蛋白(Intravenous immunoglobulin,IVIG)无反应川崎病(Kawasaki disease,KD)患儿的治疗价值。方法收集143例初次IVIG无反应川崎病患儿临床资料,将研究对象分为3组:再次IVIG组(107例)、激素组(口服或者静滴激素者12例)、再次IVIG+激素组(再次IVIG使用后临床症状仍不缓解加用口服或者静滴激素者24例)。收集3组患儿临床资料进行回顾性分析并对其心脏超声进行随访。为进一步探究激素使用方式对急性期治疗效果及冠状动脉的远期影响,将激素组、再次IVIG+激素组按激素治疗方式分为口服激素组和静滴序贯口服激素组,并对两组资料进行统计学分析。结果1.再次IVIG组、激素组、再次IVIG+激素组比较:再次IVIG组与再次IVIG+激素组比较:两组在热退时间、降低中性粒细胞百分比(N%)、急性期冠脉扩张的发生率均无统计学差异(P0.05);再次ivig组在缩短总热程、降低白细胞(wbc)水平优于再次ivig+激素组(p=0.015);降低c-反应蛋白(crp)水平弱于再次ivig+激素组(p=0.032);两组血小板(plt)均增高,再次ivig组增高幅度低于再次ivig+激素组(p=0.029);急性期冠脉瘤发生率、半年时冠脉扩张发生率低于再次ivig+激素组(p0.05);但两组在1年后冠脉病变发生率并无差异(p0.05)。再次ivig组与激素组比较:在热退时间、降低n%及crp水平、增加plt水平、对急性期冠脉瘤发生率及冠脉远期影响均无统计学差异(p0.05);在缩短总热程、降低wbc水平优于激素组(p0.05),急性期冠脉扩张发生率高于激素组(52.8%vs16.7%,p=0.029)。激素组与再次ivig+激素组比较:在总热程、热退时间、升高wbc、降低n%等方面无统计学差异(p0.05);再次ivig+激素组中crp显著降低、plt显著升高(p0.05);治疗后1周内冠脉病变发生率激素组低于再次ivig+激素组(p0.05);但两者半年后冠脉病变发生率均无统计学差异。2.口服激素组与静滴序贯口服激素组比较:口服普通剂量泼尼松组与静滴普通剂量甲强龙序贯口服泼尼松组在总热程、热退时间、升高wbc、降低n%和crp水平、急性期及随访至1年时冠脉病变发生率均无统计学差异(p0.05),但静滴序贯口服激素组血小板显著升高,差异有统计学意义(p=0.010)。结论本研究提示对初次ivig无反应kd患儿直接应用激素治疗有效,且相对安全,不增加远期冠脉病变发生率;对两剂IVIG无反应后应用激素补救治疗不影响冠脉远期预后;对IVIG无反应KD加用激素治疗,选择普通剂量激素口服或者静滴序贯口服方式对急性期治疗效果及远期预后的影响无显著差异,但由于静滴途径显著增加血小板水平,导致血栓形成风险增高,故口服激素可能是更好的选择。糖皮质激素应该作为IVIG无反应KD的首选治疗或两次IVIG无反应后的补救治疗,仍需多中心、随机、双盲、大样本的前瞻性研究。
[Abstract]:Objective to investigate the therapeutic value of hormones in children with intravenous gamma globulin (Intravenous immunoglobulin,IVIG)-inresponsive Kawasaki disease (Kawasaki disease,KD). Methods Clinical data of 143 children with primary IVIG non-reactive Kawasaki disease were collected. The subjects were divided into three groups: IVIG group (107 cases), hormone group (12 cases) and IVIG group (24 cases). The clinical data of 3 groups were analyzed retrospectively and followed up by echocardiography. In order to further explore the long-term effects of hormone use on acute phase therapy and coronary artery, hormone group and IVIG group were divided into oral hormone group and intravenous drip sequential oral hormone group according to hormone therapy. Two groups of data were analyzed statistically. Result 1. Re IVIG group, hormone group, re IVIG hormone group comparison: re IVIG group and re IVIG hormone group comparison: the two groups in the heat receding time, The percentage of neutrophils decreased (N%), the incidence of coronary artery dilatation in acute phase was not significantly different (P0.05). The decrease of leukocyte (wbc) level was better than that of ivig hormone group (p0. 015), the decrease of c-reactive protein (crp) level was weaker than that of re ivig hormone group (p0. 032), the increase of platelet (plt) was higher in both groups, and the increase in ivig group was lower than that in re ivig hormone group (p0. 029). The incidence of coronary artery dilatation was lower in half a year than that in ivig group (p0.05), but there was no difference between the two groups after one year (p0.05). There was no significant difference between the ivig group and the hormone group in the incidence of coronary aneurysm and the long-term effect of coronary artery on the incidence of acute coronary artery aneurysm and the long-term effect of coronary artery in the treatment group (p0. 05), but in shortening the total fever course, there was no significant difference in the incidence of coronary artery aneurysm and the long-term effect of coronary artery in ivig group (p0.05). The incidence of coronary artery dilatation in acute phase was higher than that in hormone group (52.8 vs 16.7p0.029). The hormone group was compared with the ivig hormone group: in the total heat course, the time of heat withdrawal, There was no significant difference in increasing wbc, and decreasing n% (p0.05); crp in ivig group decreased significantly and plt increased significantly (p0.05); the incidence of coronary artery lesion in steroid group was lower than that in ivig group within 1 week after treatment, but the coronary artery lesion occurred half a year after treatment. There was no statistical difference in the rate of birth. 2. Comparison between oral hormone group and sequential oral hormone group: prednisone group and prednisone group were treated with prednisone in the total heat course, the time of heat withdrawal, the increase of wbc, and the decrease of n% and crp levels. There was no significant difference in the incidence of coronary artery lesion in acute phase and follow-up to one year (p0.05), but the platelet level was significantly increased in intravenous drip sequential oral hormone group (p0. 010). Conclusion this study suggests that hormone therapy is effective and relatively safe in primary ivig patients with non-reactive kd, and does not increase the incidence of long-term coronary artery disease, and the long-term prognosis of coronary artery is not affected by hormone therapy after two doses of IVIG. There was no significant difference in the effect of routine oral administration or sequential oral administration of intravenous drip on the efficacy and long-term prognosis of IVIG non-reactive KD, but the platelet level was significantly increased by intravenous drip. Lead to increased risk of thrombosis, so oral hormone may be a better choice. Glucocorticoids should be the preferred treatment for IVIG non-reactive KD or for two IVIG non-reactive remediation. A multicenter, randomized, double-blind, large sample prospective study is still required.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R725.4
本文编号：2274293
[Abstract]:Objective to investigate the therapeutic value of hormones in children with intravenous gamma globulin (Intravenous immunoglobulin,IVIG)-inresponsive Kawasaki disease (Kawasaki disease,KD). Methods Clinical data of 143 children with primary IVIG non-reactive Kawasaki disease were collected. The subjects were divided into three groups: IVIG group (107 cases), hormone group (12 cases) and IVIG group (24 cases). The clinical data of 3 groups were analyzed retrospectively and followed up by echocardiography. In order to further explore the long-term effects of hormone use on acute phase therapy and coronary artery, hormone group and IVIG group were divided into oral hormone group and intravenous drip sequential oral hormone group according to hormone therapy. Two groups of data were analyzed statistically. Result 1. Re IVIG group, hormone group, re IVIG hormone group comparison: re IVIG group and re IVIG hormone group comparison: the two groups in the heat receding time, The percentage of neutrophils decreased (N%), the incidence of coronary artery dilatation in acute phase was not significantly different (P0.05). The decrease of leukocyte (wbc) level was better than that of ivig hormone group (p0. 015), the decrease of c-reactive protein (crp) level was weaker than that of re ivig hormone group (p0. 032), the increase of platelet (plt) was higher in both groups, and the increase in ivig group was lower than that in re ivig hormone group (p0. 029). The incidence of coronary artery dilatation was lower in half a year than that in ivig group (p0.05), but there was no difference between the two groups after one year (p0.05). There was no significant difference between the ivig group and the hormone group in the incidence of coronary aneurysm and the long-term effect of coronary artery on the incidence of acute coronary artery aneurysm and the long-term effect of coronary artery in the treatment group (p0. 05), but in shortening the total fever course, there was no significant difference in the incidence of coronary artery aneurysm and the long-term effect of coronary artery in ivig group (p0.05). The incidence of coronary artery dilatation in acute phase was higher than that in hormone group (52.8 vs 16.7p0.029). The hormone group was compared with the ivig hormone group: in the total heat course, the time of heat withdrawal, There was no significant difference in increasing wbc, and decreasing n% (p0.05); crp in ivig group decreased significantly and plt increased significantly (p0.05); the incidence of coronary artery lesion in steroid group was lower than that in ivig group within 1 week after treatment, but the coronary artery lesion occurred half a year after treatment. There was no statistical difference in the rate of birth. 2. Comparison between oral hormone group and sequential oral hormone group: prednisone group and prednisone group were treated with prednisone in the total heat course, the time of heat withdrawal, the increase of wbc, and the decrease of n% and crp levels. There was no significant difference in the incidence of coronary artery lesion in acute phase and follow-up to one year (p0.05), but the platelet level was significantly increased in intravenous drip sequential oral hormone group (p0. 010). Conclusion this study suggests that hormone therapy is effective and relatively safe in primary ivig patients with non-reactive kd, and does not increase the incidence of long-term coronary artery disease, and the long-term prognosis of coronary artery is not affected by hormone therapy after two doses of IVIG. There was no significant difference in the effect of routine oral administration or sequential oral administration of intravenous drip on the efficacy and long-term prognosis of IVIG non-reactive KD, but the platelet level was significantly increased by intravenous drip. Lead to increased risk of thrombosis, so oral hormone may be a better choice. Glucocorticoids should be the preferred treatment for IVIG non-reactive KD or for two IVIG non-reactive remediation. A multicenter, randomized, double-blind, large sample prospective study is still required.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R725.4
【参考文献】
相关期刊论文 前1条
1 赵晓东;杜忠东;;川崎病专题讨论会纪要[J];中华儿科杂志;2007年11期
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