大剂量静脉丙种球蛋白无反应性川崎病危险因素分析

发布时间：2019-03-02 16:46

【摘要】：目的探讨大剂量静脉丙种球蛋白(IVIG)无反应性川崎病的发病率、相关危险因素及再治疗情况。方法回顾分析2011.08至2012.08我院住院治疗的544例川崎病患儿的临床资料。根据对首次大剂量IVIG有无反应，将对IVIG治疗无效者定为无反应组，有效者为敏感组。分析比较两组患儿的临床表现、一般情况、实验室指标、超声心动图及心电图等检查结果。结果544例于起病10天内接受IVIG冲击治疗的KD患儿被纳入研究对象，，其中无反应组54例(9.93%)，敏感组490例(90.07%)。无反应组冠脉病变的并发率与敏感组相近（P0.05)。单因素分析发现无反应组发热持续时间较敏感组长，眼结合膜充血发生率低，淋巴细胞百分比下降更明显(p0.05)。Logistic回归分析发现发热持续时间长是IVIG无反应性的独立危险因素(P0.05)。无反应组出现窦性心动过速及一度房室传导阻滞的可能性更大(P0.05)。54例无反应组患儿中，28例接受了IVIG2g/kg再次冲击治疗，均一次给药。其中25例患儿治疗有效，2例患儿加用糖皮质激素治疗后体温恢复正常，1例加用英夫利西治疗后体温恢复正常， IVIG再次治疗方案有效率为89.2%。25例(43.1%) IVIG无反应性KD患儿在首次IVIG治疗后3-4d自行退热。这部分患儿的住院时间、发热持续时间、治疗后的发热时间明显短于再次接受IVIG冲击治疗的患儿(P0.05)。且该部分患儿的贫血程度较轻，血小板升高不显著(P0.05)，冠状动脉病变发生率与再次IVIG治疗组无明显差异(P＞0.05)。结论该组病例中IVIG无反应性川崎病发生率约9.93%。发热持续时间长是IVIG无反应性的独立危险因素。首次IVIG治疗后3-4天内自行退热的IVIG无反应性川崎病，对冠脉病变的后期恢复无明显影响，临床上观察首次IVIG治疗后发热时间可适当延长。对首剂IVIG无效的KD患儿，推荐予IVIG (2g/kg)再次冲击治疗；仍无效者，可予激素治疗。心电图检查对早期评估川崎病心脏受累情况有重大意义。
[Abstract]:Objective to investigate the incidence, risk factors and retreatment of high-dose intravenous gamma globulin (IVIG) non-reactive Kawasaki disease (Kawasaki disease). Methods the clinical data of 544 children with Kawasaki disease from 2011.08 to 2012.08 in our hospital were retrospectively analyzed. According to the response to the first large dose of IVIG, the patients who did not respond to IVIG treatment were classified as no-response group and the sensitive group as the effective group. The clinical manifestations, general conditions, laboratory parameters, echocardiography and ECG were analyzed and compared between the two groups. Results 544 children with KD who received IVIG shock therapy within 10 days of onset were included in the study. There were 54 cases (9.93%) in the non-reactive group and 490 cases (90.07%) in the sensitive group. The complication rate of coronary artery lesion in non-reaction group was similar to that in sensitive group (P0.05). Univariate analysis showed that the duration of fever in the non-reactive group was longer than that in the control group, and the incidence of eye-binding membrane congestion was lower. Logistic regression analysis showed that long duration of fever was an independent risk factor for non-reactivity of IVIG (P0.05). In the non-reactive group, sinus tachycardia and one-degree atrioventricular block were more likely to occur (P0.05). Of the 54 non-reactive children, 28 received IVIG2g/kg repulse therapy, all of which were given once. Among them, 25 cases were treated effectively, 2 cases returned to normal after glucocorticoid treatment, and 1 case returned to normal temperature after inflixime treatment, and 2 cases were treated with glucocorticoid, 2 cases were treated with glucocorticoid and 1 case returned to normal temperature. The effective rate of IVIG retherapy was 89.2%. 25 cases (43.1%) of IVIG non-reactive KD were treated with IVIG for 3-4 days. The duration of hospitalization, duration of fever and duration of fever after treatment were significantly shorter than those who received IVIG shock therapy again (P0.05). There was no significant difference in the incidence of coronary artery disease between the two groups (P0.05). There was no significant difference in the incidence of coronary artery disease between the two groups (P > 0.05). Conclusion the incidence of IVIG non-reactive Kawasaki disease in this group is about 9.93%. Long duration of fever is an independent risk factor for non-reactivity of IVIG. IVIG non-reactive Kawasaki disease (Kawasaki disease) with spontaneous antipyretic activity within 3 days after the first IVIG treatment had no significant effect on the late recovery of coronary artery disease. The fever time after the first IVIG treatment could be properly prolonged. IVIG (2g/kg) is recommended for children with KD whose first dose of IVIG is ineffective, and hormone therapy is recommended for those who are still ineffective. ECG examination is of great significance for early assessment of cardiac involvement in Kawasaki disease.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R725.4

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