Kobayashi Tohru, Inoue Yoshinari, Otani Tetsuya, Morikawa Akihiro, Kobayashi Tomio, Takeuchi Kazuo, Saji Tsutomu, Sonobe Tomoyoshi, Ogawa Shunichi, Miura Masaru, Arakawa Hirokazu
Department of Pediatrics, Gunma University Graduate School of Medicine, Gunma, Japan.
Pediatr Infect Dis J. 2009 Jun;28(6):498-502. doi: 10.1097/inf.0b013e3181950b64.
We reported previously that intravenous immunoglobulin (IVIG) plus prednisolone for initial therapy for Kawasaki disease (KD) prevented coronary artery abnormalities (CAA) more effectively than IVIG alone. However, questions remain as to whether PSL has potential benefit in all KD patients. The present study was designed to explore the possibility of stratified initial therapy including PSL in patients with and without a high predicted risk of being an IVIG nonresponder.
We retrospectively analyzed data from KD patients who received IVIG (n = 896) or IVIG + PSL (n = 110) by scoring the likely risk of being an IVIG nonresponder. We compared clinical and coronary outcomes between treatment-defined groups separately for high- and low-risk patients.
Among low-risk patients (score 0-4), clinical and coronary outcomes were similar. Among high-risk patients (score 5 or more), incidences of treatment failure and coronary artery abnormalities until 1-month follow-up were more frequent in the IVIG than in the IVIG + PSL group. Sex- and score point-adjusted odds ratios for IVIG + PSL were 0.17 (95% confidence interval, 0.08-0.39) for treatment failure and 0.27 (95% confidence interval, 0.07-0.85) for coronary artery abnormalities A among high-risk patients.
IVIG + PSL treatment was associated with improving clinical and coronary outcomes in patients at high risk of being IVIG nonresponders.
我们之前报道过，静脉注射免疫球蛋白（IVIG）联合泼尼松龙用于川崎病（KD）的初始治疗比单独使用IVIG更有效地预防冠状动脉异常（CAA）。然而，泼尼松龙（PSL）是否对所有KD患者都有潜在益处仍存在疑问。本研究旨在探讨对有和没有IVIG无反应高预测风险的患者进行分层初始治疗（包括PSL）的可能性。
我们回顾性分析了接受IVIG（n = 896）或IVIG + PSL（n = 110）治疗的KD患者的数据，通过对IVIG无反应的可能风险进行评分。我们分别比较了高风险和低风险患者中治疗定义组之间的临床和冠状动脉结局。
在低风险患者（评分0 - 4）中，临床和冠状动脉结局相似。在高风险患者（评分5或更高）中，直到1个月随访时，IVIG组的治疗失败和冠状动脉异常发生率比IVIG + PSL组更频繁。在高风险患者中，IVIG + PSL的性别和评分点调整后的治疗失败比值比为0.17（95%置信区间，0.08 - 0.39），冠状动脉异常A的比值比为0.27（95%置信区间，0.07 - 0.85）。
IVIG + PSL治疗与改善IVIG无反应高风险患者的临床和冠状动脉结局相关。
