Wang Xiaoli, Shi Xiaosong, Guo Xinxin, Chen Shengwei, Lin Xinyu, Yang Fang
Department of Pediatrics, Provincial Clinical Medical College of Fujian Medical University, Fujian, Fuzhou University Affiliated Provincial Hospital, Fujian Provincial Hospital, Dongjie 134, Gulou District, Fuzhou, People's Republic of China, 350001.
Pediatr Cardiol. 2024 Sep 24. doi: 10.1007/s00246-024-03657-9.
This retrospective study assessed the efficacy of initial treatment with intravenous immunoglobulin (IVIG), aspirin, and corticosteroids in Kawasaki disease (KD) patients at risk for IVIG resistance. Data from pediatric patients with KD between January 2010 and December 2019 were divided into the IVIG-sensitive and IVIG-resistant groups based on treatment response. Risk factors for IVIG resistance were identified through univariate analysis. Outcomes included comparison of fever resolution time, hospital stay, and coronary artery lesion (CALs) incidence at multiple intervals post-treatment. An observational group (January 2020 to December 2022) was given additional methylprednisolone if they exhibited three or more IVIG resistance risk factors. The IVIG-resistant group had a higher proportion of males and significantly elevated inflammatory markers (CRP, ESR, PCT) and TBIL, NT-proBNP compared to the IVIG-sensitive group (all p < 0.05), while showing lower levels of albumin, ARR (AST/ALT ratio), and serum sodium (all p < 0.05). Both the IVIG-sensitive and observational groups had significantly shorter fever resolution times and hospital stays than the IVIG-resistant group (all p < 0.05). CALs incidence was consistently higher in the IVIG-resistant group across all follow-up periods (all p < 0.05), with significant differences observed between the observational group and IVIG-resistant group at 1-month, 3-month, and 6-month post-treatment (all p < 0.05). Notably, prior to treatment, the observational group had a higher CALs incidence compared to the IVIG-sensitive group (all p < 0.05). In children with KD who exhibit ≥ 3 risk factors for IVIG non-response, initial treatment with IVIG, aspirin, and glucocorticoids can effectively reduce fever duration, hospitalization duration, and incidence of CALs and is considered safe.
这项回顾性研究评估了静脉注射免疫球蛋白（IVIG）、阿司匹林和皮质类固醇初始治疗对有IVIG抵抗风险的川崎病（KD）患者的疗效。2010年1月至2019年12月期间儿科KD患者的数据根据治疗反应分为IVIG敏感组和IVIG抵抗组。通过单因素分析确定IVIG抵抗的危险因素。结果包括比较治疗后多个时间点的发热消退时间、住院时间和冠状动脉病变（CALs）发生率。观察组（2020年1月至2022年12月）如果表现出三个或更多IVIG抵抗危险因素，则给予额外的甲泼尼龙。与IVIG敏感组相比，IVIG抵抗组男性比例更高，炎症标志物（CRP、ESR、PCT）和TBIL、NT-proBNP显著升高（所有p<0.05），而白蛋白、ARR（AST/ALT比值）和血清钠水平较低（所有p<0.05）。IVIG敏感组和观察组的发热消退时间和住院时间均明显短于IVIG抵抗组（所有p<0.05）。在所有随访期间，IVIG抵抗组的CALs发生率始终较高（所有p<0.05），观察组与IVIG抵抗组在治疗后1个月、3个月和6个月有显著差异（所有p<0.05）。值得注意的是，治疗前，观察组的CALs发生率高于IVIG敏感组（所有p<0.05）。在表现出≥3个IVIG无反应危险因素的KD儿童中，IVIG、阿司匹林和糖皮质激素初始治疗可有效缩短发热持续时间、住院时间和CALs发生率，且被认为是安全的。
