Peng Yue, Jing Fengchuan, Liu Dong, Li Bin, Xu Yanxia, Tan Zhongyou, Chen Ouyang, Yang Yanfeng, Si Feifei, Jiang Wenliang, Li Cong, Cheng Zhenli, Zhou Xue, Feng Siqi, Su Ya, Yi Qijian
Department of Cardiovascular Medicine, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, People's Republic of China.
Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, People's Republic of China.
J Inflamm Res. 2025 May 2;18:5923-5929. doi: 10.2147/JIR.S513963. eCollection 2025.
Intravenous immunoglobulin (IVIG) resistance is associated with coronary artery abnormalities in Kawasaki disease (KD) and requires additional therapy. The purpose of this study was to determine independent risk factors for IVIG resistance, investigate the response to IVIG treatment at different time points and determine whether the time option of IVIG treatment altered IVIG resistance.
The clinical data of 6264 KD patients in southwest China were analyzed retrospectively. According to the response to IVIG treatment, the patients were divided into IVIG response group and IVIG resistance group. Multiple logistic regression model was used to identify independent risk factors for IVIG resistance, and trend chi-square test was used to examine the effect of IVIG timing on IVIG resistance.
Multivariate analysis showed that IVIG time, WBC, PLT, HB, ALT and Na were independently associated with IVIG resistance, and IVIG time was a key variable for IVIG resistance. In addition, these data suggested that the rate of IVIG resistance was the lowest when treated with IVIG on the seventh and eighth day of initial fever.
IVIG timing is a key factor in IVIG resistance. Our data suggest a lower resistance rate when IVIG is administered on the seventh and eighth day of initial fever. However, the clinical implications of delaying treatment are uncertain, and early IVIG administration remains essential to prevent cardiovascular complications. Further research is needed to validate these findings and to guide clinical practice.
静脉注射免疫球蛋白（IVIG）抵抗与川崎病（KD）的冠状动脉异常相关，需要额外治疗。本研究的目的是确定IVIG抵抗的独立危险因素，调查不同时间点对IVIG治疗的反应，并确定IVIG治疗的时间选择是否会改变IVIG抵抗。
回顾性分析中国西南部6264例KD患者的临床资料。根据对IVIG治疗的反应，将患者分为IVIG反应组和IVIG抵抗组。采用多因素logistic回归模型确定IVIG抵抗的独立危险因素，采用趋势卡方检验分析IVIG治疗时机对IVIG抵抗的影响。
多因素分析显示，IVIG治疗时间、白细胞（WBC）、血小板（PLT）、血红蛋白（HB）、谷丙转氨酶（ALT）和血钠（Na）与IVIG抵抗独立相关，且IVIG治疗时间是IVIG抵抗的关键变量。此外，这些数据表明，在初次发热的第7天和第8天接受IVIG治疗时，IVIG抵抗率最低。
IVIG治疗时机是IVIG抵抗的关键因素。我们的数据表明，在初次发热的第7天和第8天给予IVIG时抵抗率较低。然而，延迟治疗的临床意义尚不确定，早期给予IVIG对于预防心血管并发症仍然至关重要。需要进一步研究来验证这些发现并指导临床实践。
