Wang Xin, Pan Si-Lin, DU Zhan-Hui, Ji Zhi-Xian, Luo Gang, Sun Hong-Xiao, Ma Shu-Jing
Heart Center, Qingdao Women and Children's Hospital, Qingdao University, Qingdao, Shandong 266034, China.
Zhongguo Dang Dai Er Ke Za Zhi. 2022 Apr 15;24(4):399-404. doi: 10.7499/j.issn.1008-8830.2110137.
To examine the association between duration of fever before intravenous immunoglobulin (IVIG) treatment and IVIG resistance in children with Kawasaki disease (KD).
A retrospective analysis was performed on the medical data of 317 children with KD who were admitted from January 2018 to December 2020. According to the duration of fever before IVIG treatment, they were divided into two groups: short fever duration group (≤4 days) with 92 children and long fever duration group (>4 days) with 225 children. According to the presence or absence of IVIG resistance, each group was further divided into a drug-resistance group and a non-drug-resistance group. Baseline data and laboratory results were compared between groups. A multivariate logistic regression analysis was used to identify the influencing factors for IVIG resistance.
In the short fever duration group, 19 children (20.7%) had IVIG resistance and 5 children (5.4%) had coronary artery aneurysm, and in the long fever duration group, 22 children (9.8%) had IVIG resistance and 19 children (8.4%) had coronary artery aneurysm, suggesting that the short fever duration group had a significantly higher rate of IVIG resistance than the long fever duration group (<0.05), while there was no significant difference in the incidence rate of coronary artery aneurysm between the two groups (>0.05). In the short fever duration group, compared with the children without drug resistance, the children with drug resistance had a significantly lower level of blood sodium and significantly higher levels of procalcitonin, C-reactive protein, and N-terminal B-type natriuretic peptide before treatment (<0.05). In the long fever duration group, the children with drug resistance had significantly lower levels of blood sodium and creatine kinase before treatment than those without drug resistance (<0.05). The multivariate logistic regression analysis showed that a reduction in blood sodium level was associated with IVIG resistance in the long fever duration group (<0.05).
IVIG resistance in children with KD varies with the duration of fever before treatment. A reduction in blood sodium is associated with IVIG resistance in KD children with a duration of fever of >4 days before treatment.
探讨川崎病（KD）患儿静脉注射免疫球蛋白（IVIG）治疗前发热持续时间与IVIG抵抗之间的关联。
对2018年1月至2020年12月收治的317例KD患儿的医疗资料进行回顾性分析。根据IVIG治疗前发热持续时间，将其分为两组：发热持续时间短组（≤4天）92例患儿和发热持续时间长组（>4天）225例患儿。根据是否存在IVIG抵抗，每组再分为耐药组和非耐药组。比较两组间的基线数据和实验室检查结果。采用多因素logistic回归分析确定IVIG抵抗的影响因素。
发热持续时间短组中，19例患儿（20.7%）存在IVIG抵抗，5例患儿（5.4%）有冠状动脉瘤；发热持续时间长组中，22例患儿（9.8%）存在IVIG抵抗，19例患儿（8.4%）有冠状动脉瘤，提示发热持续时间短组IVIG抵抗发生率显著高于发热持续时间长组（<0.05），而两组冠状动脉瘤发生率差异无统计学意义（>0.05）。发热持续时间短组中，与无耐药的患儿相比，有耐药的患儿治疗前血钠水平显著降低，降钙素原、C反应蛋白和N末端B型利钠肽水平显著升高（<0.05）。发热持续时间长组中，有耐药的患儿治疗前血钠水平和肌酸激酶水平显著低于无耐药的患儿（<0.05）。多因素logistic回归分析显示，血钠水平降低与发热持续时间长组的IVIG抵抗相关（<0.05）。
KD患儿的IVIG抵抗随治疗前发热持续时间而异。血钠降低与治疗前发热持续时间>4天的KD患儿的IVIG抵抗相关。
