Yanagawa H, Nakamura Y, Sakata K, Yashiro M
Department of Public Health, Jichi Medical School, Tochigi-ken, Japan.
Pediatr Cardiol. 1997 Jan-Feb;18(1):19-23. doi: 10.1007/s002469900102.
The administration of intravenous gamma-globulin (IVGG) for Kawasaki disease was investigated throughout Japan in 1993 by obtaining information from pediatric departments in 2652 hospitals that had more than 100 beds. Of 11,221 reported patients, 8958 patients (79.8%) received IVGG treatment. Of all the patients to whom IVGG was administered, the most common total dose was 1000 mg/kg (36.3%) followed by 2000 mg/kg (16.9%) and 1200 mg/kg (16.8%). The treatment was started in 53.8% by day 5 of the illness and in 83.7% by day 7. The proportion of those with cardiac sequelae was higher among patients administered > 2000 mg/kg or in those started on IVGG on day 9 of their illness or later. The possible reasons are (1) those who were more severely affected were treated with high-dose IVGG earlier; or (2) IVGG does not effectively prevent cardiac sequelae. We concluded that there is a risk of unfavorable effects with IVGG regarding cardiac sequelae when the IVGG dose is > 2000 mg/kg or if IVGG is started on day 9 or later. We believe that only a randomized controlled trial, undertaken prospectively, can adequately address the question of the optimal use of IVGG.
1993年，通过向日本2652家拥有100张以上床位医院的儿科部门收集信息，对静脉注射丙种球蛋白（IVGG）治疗川崎病的情况进行了全面调查。在11221例报告病例中，8958例患者（79.8%）接受了IVGG治疗。在所有接受IVGG治疗的患者中，最常用的总剂量是1000mg/kg（36.3%），其次是2000mg/kg（16.9%）和1200mg/kg（16.8%）。53.8%的患者在发病第5天开始治疗，83.7%在第7天开始治疗。接受>2000mg/kg剂量IVGG治疗的患者，或在发病第9天及以后开始接受IVGG治疗的患者，发生心脏后遗症的比例更高。可能的原因是：（1）病情较重的患者更早接受了高剂量IVGG治疗；或者（2）IVGG不能有效预防心脏后遗症。我们得出结论，当IVGG剂量>2000mg/kg或在发病第9天及以后开始使用IVGG时，存在IVGG导致心脏后遗症不良影响的风险。我们认为，只有前瞻性地进行随机对照试验，才能充分解决IVGG最佳使用的问题。
