[川崎病早期、常规及晚期静脉注射丙种球蛋白治疗的疗效比较]

[Comparison of efficacy among early, conventional and late intravenous gamma globulin treatment of Kawasaki disease].

作者信息

Du Zhong-Dong, Di Zhao, Du Jun-Bao, Lu Shan, Yi Jing-Mei, Hou An-Cun, Zhou Zhong-Shu, Ding Guo-Fang

机构信息

Beijing Kawasaki Disease Research Group, Department of Cardiology, Beijing Children's Hospital, Capital Medical University, Beijing 10045, China.

出版信息

Zhonghua Yi Xue Za Zhi. 2009 Jul 14;89(26):1841-3.

PMID:19953930

Abstract

OBJECTIVE

To compare the rates of intravenous gamma globulin (IVIG) non-responder and coronary complication among early, conventional and late IVIG treatment in children with Kawasaki disease (KD).

METHODS

All children with KD and IVIG treatment were retrospectively analyzed at 45 hospitals in Beijing during the 5-year period from 2000 through 2004. The time of IVIG treatment was classified as early (Day 1 - 4), conventional (Day 5 - 9) and late treatment group (Day 10 or later). The efficacy of IVIG was judged by the rate of IVIG non-responder. Echocardiography was used to assess the coronary complication at acute (1 - 2 weeks after onset) and sub-acute (3 - 6 weeks after onset) stage.

RESULTS

A total of 1052 patients (680 boys, 372 girls) aged 2 months to 13.8 years were included. They were grouped as early, conventional and late treatment in 108, 763 and 181 children respectively. The rate of IVIG non-responders was higher in early (28.7%, 31/108) as compared with conventional (11.9%, 91/763) and late treatment group (7.2%, 13/181, both P < 0.01). The incidences of coronary complications were similar in early (17.6%, 19/108 and 5.9%, 4/68) and conventional treatment group (18.3%, 140/ 763 and 5.5%, 25/452), while significantly higher in late treatment group (33.7%, 61/181 and 12.8%, 15/117) in acute and sub-acute stages (both P < 0.01).

CONCLUSIONS

IVIG treatment in children with KD for a disease duration of 1 - 4 days appeared to increase the rate of IVIG non-responders. Children with IVIG given at Day 10 or later had a higher incidence of acute and sub-acute coronary complications. IVIG given at Day 5 - 9 seems to be the best time for IVIG therapy in KD.

摘要

目的

比较川崎病（KD）患儿早期、常规及晚期静脉注射丙种球蛋白（IVIG）治疗时IVIG无反应率及冠状动脉并发症发生率。

方法

回顾性分析2000年至2004年期间北京45家医院所有接受KD治疗并使用IVIG的患儿。IVIG治疗时间分为早期（第1 - 4天）、常规（第5 - 9天）和晚期治疗组（第10天及以后）。通过IVIG无反应率判断IVIG疗效。采用超声心动图评估急性期（发病后1 - 2周）和亚急性期（发病后3 - 6周）的冠状动脉并发症。

结果

共纳入1052例年龄2个月至13.8岁的患儿（男680例，女372例）。分别将108例、763例和181例患儿分为早期、常规和晚期治疗组。早期治疗组IVIG无反应率（28.7%，31/108）高于常规治疗组（11.9%，91/763）和晚期治疗组（7.2%，13/181，P均<0.01）。早期治疗组（17.6%，19/108和5.9%，4/68）和常规治疗组（18.3%，140/763和5.5%，25/452）急性期和亚急性期冠状动脉并发症发生率相似，而晚期治疗组（33.7%，61/181和12.8%，15/117）显著更高（P均<0.01）。