Tse Shirley M L, Silverman Earl D, McCrindle Brian W, Yeung Rae S M
Division of Rheumatology and Cardiology, Department of Pediatrics, Hospital for Sick Children, Hospital for Sick Children Research Institute, University of Toronto, Ontario, Canada.
J Pediatr. 2002 Apr;140(4):450-5. doi: 10.1067/mpd.2002.122469.
To determine if a shorter interval between Kawasaki disease (KD) treatment with intravenous immunoglobulin (IVIG) and fever onset results in increased treatment failures, need for adjunctive therapy, or development of coronary artery lesions.
Patients with KD (n = 178; 89 matched pairs) diagnosed between 1987 and 1999 were included in this case-control study. All patients had fever plus at least 4 of the 5 clinical criteria for KD. Eighty-nine patients who received IVIG at day 5 or earlier were matched to patients diagnosed within 4 weeks and given IVIG at days 6 to 9 of fever. Compiled data from a detailed chart review included demographics, clinical features, fever duration, investigations, disease course, and response to therapy. Differences between matched case and control pairs were analyzed by means oft tests and McNemar tests.
No demographic differences were noted between the two groups. Patients treated on day 5 or less of fever had a shorter total fever duration (5.2 +/- 1.9 days vs 8.0 +/- 1.8 days, P <.0001), longer fever after IVIG treatment (1.5 +/- 1.9 days vs 0.8 +/- 1.3 days, P =.008), and less coronary artery ectasia at 1 year after KD onset (4% vs 16%, P =.02). There was no significant difference between cases and control patients in the number of patients with KD recrudescence, need for repeat courses of IVIG, need for corticosteroids, length of hospitalization, or development of coronary artery aneurysms within the first 3 months. Patients who were treated on day 5 or less of fever had higher levels of serum albumin (36 +/- 5 g/L vs 33 +/- 5 g/L, P <.01) and serum ALT (115 +/- 155 U/L vs 46 +/- 49 U/L, P <.001) as well as a lower platelet count (354 +/- 131 vs 403 +/- 166, P =.02) than did control patients during the acute phase.
Early treatment of KD resulted in less coronary ectasia at 1 year after KD onset but was not associated with a quicker resolution of fever, an increased number of treatment failures, an increased need for adjunctive therapy, length of hospitalization, nor development of coronary artery lesions. In children with fever and classic clinical and laboratory findings of KD, treatment with IVIG on or before 5 days of fever resulted in better coronary outcomes and decreased the total length of time of clinical symptoms.
确定川崎病（KD）静脉注射免疫球蛋白（IVIG）治疗与发热开始之间较短的间隔是否会导致治疗失败增加、辅助治疗需求增加或冠状动脉病变的发生。
本病例对照研究纳入了1987年至1999年间诊断的KD患者（n = 178；89对匹配病例）。所有患者均有发热且至少具备KD的5项临床标准中的4项。89例在第5天或更早接受IVIG治疗的患者与在4周内确诊且在发热第6至9天接受IVIG治疗的患者进行匹配。从详细的病历回顾中汇编的数据包括人口统计学、临床特征、发热持续时间、检查、病程及对治疗的反应。通过t检验和McNemar检验分析匹配病例组与对照组之间的差异。
两组之间未发现人口统计学差异。在发热第5天或更短时间接受治疗的患者总发热持续时间较短（5.2±1.9天对8.0±1.8天，P<.0001），IVIG治疗后发热时间较长（1.5±1.9天对0.8±1.3天，P =.008），且KD发病1年后冠状动脉扩张较少（4%对16%，P =.02）。KD复发患者数量、IVIG重复疗程需求、皮质类固醇需求住院时间或前3个月内冠状动脉瘤的发生在病例组和对照组患者之间无显著差异。在急性期，发热第5天或更短时间接受治疗的患者血清白蛋白水平较高（36±5 g/L对33±5 g/L，P<.01）、血清ALT水平较高（115±155 U/L对46±49 U/L，P<.001），且血小板计数较低（354±131对403±166，P =.02）。
KD的早期治疗在KD发病1年后导致冠状动脉扩张较少，但与发热更快消退、治疗失败数量增加、辅助治疗需求增加、住院时间或冠状动脉病变的发生无关。对于有发热及KD典型临床和实验室表现的儿童，在发热5天或之前用IVIG治疗可带来更好的冠状动脉结局并缩短临床症状的总时长。
