Ichihashi Ko, Shiraishi Hirohiko, Momoi Mariko
Department of Pediatrics, Saitama Medical Center of Jichi Medical University, Saitama, Japan.
Cardiol Young. 2009 Jun;19(3):224-7. doi: 10.1017/S1047951109003709. Epub 2009 Mar 10.
Standard treatment of acute Kawasaki disease involves giving 2 grams per kilogram of immunoglobulin intravenously along with aspirin. More than half of the patients with acute Kawasaki disease, nonetheless, can be cured by giving only 1 gram per kilogram of immunoglobulin, thus reducing this aspect of the cost of treatment by half. Our purpose was to predict those patients with acute Kawasaki disease who would respond to treatment with 1 gram per kilogram of immunoglobulin given intravenously on the basis of their clinical profiles and laboratory findings prior to the initial treatment. We performed a retrospective review of the clinical records of consecutive patients with acute Kawasaki disease treated in our hospital with intravenous immunoglobulin from January, 2001, to December, 2005.During this period, we treated in this fashion 98 patients with acute Kawasaki disease. 65% of these needing immunoglobulin therapy were cured by giving 1 gram per kilogram. The neutrophil count and the percentage of white blood cells representing neutrophils, along with aspirate aminotransferase, alanine aminotransferase, bilirubin and C reactive protein, were all significantly lower, and sodium was significantly higher, in those responding to 1 gram per kilogram of immunoglobulin when compared to those who did not respond. The days of illness at the first intravenous treatment was later in those responding than in those failing to respond. We generated a score for prediction, assigning a point for each of C reactive protein equal to or greater than 10 mg/dl, sodium equal to or lower than 133 meq/l, alanine aminotransferase equal to or greater than 110 IU/l, and 2 points for the percentage of white blood cells representing neutrophils equal to or greater than 70%. Using a cut-off point of a score less than 2, we were able to identify those responding with 60% sensitivity, and 91% specificity.Thus, we are now able to predict those patients with acute Kawasaki disease who will respond to immunoglobulin given intravenously at 1 gram per kilogram using laboratory data, with a potential saving in medical costs.
急性川崎病的标准治疗方法是静脉注射每千克2克免疫球蛋白并同时服用阿司匹林。然而，超过半数的急性川崎病患者仅通过静脉注射每千克1克免疫球蛋白就能治愈，从而使这方面的治疗费用减半。我们的目的是根据急性川崎病患者初始治疗前的临床特征和实验室检查结果，预测哪些患者对静脉注射每千克1克免疫球蛋白的治疗有反应。我们对2001年1月至2005年12月在我院接受静脉注射免疫球蛋白治疗的连续性急性川崎病患者的临床记录进行了回顾性分析。在此期间，我们以这种方式治疗了98例急性川崎病患者。其中65%需要免疫球蛋白治疗的患者通过每千克1克的剂量治愈。与无反应者相比，对每千克1克免疫球蛋白有反应者的中性粒细胞计数、中性粒细胞占白细胞的百分比、谷草转氨酶、谷丙转氨酶、胆红素和C反应蛋白均显著降低，而钠显著升高。首次静脉治疗时的病程天数在有反应者中比无反应者晚。我们生成了一个预测分数，C反应蛋白等于或大于10mg/dl、钠等于或低于133meq/l、谷丙转氨酶等于或大于110IU/l各计1分，中性粒细胞占白细胞的百分比等于或大于70%计2分。使用分数小于2作为截断点，我们能够以60%的敏感性和91%的特异性识别出有反应者。因此，我们现在能够利用实验室数据预测哪些急性川崎病患者对每千克1克静脉注射免疫球蛋白有反应，从而有可能节省医疗费用。
