ISSN 1674-3865  CN 21-1569/R
主管：国家卫生健康委员会
主办：中国医师协会
　　　辽宁省基础医学研究所
　　　辽宁中医药大学附属医院
中国中西医结合儿科学

中国中西医结合儿科学 ›› 2017, Vol. 9 ›› Issue (4): 308-311.doi: 10.3969/j.issn.1674-3865.2017.04.011

• 临床研究 • 上一篇    下一篇

对静脉注射丙种球蛋白无反应性川崎病的治疗及危险因素分析

梅翎   

  1. 110032 沈阳，沈阳市儿童医院内二科
  • 出版日期:2017-08-25 发布日期:2017-12-08
  • 作者简介:梅翎（1983-），主治医师。研究方向：小儿呼吸、循环系统疾病的诊治，E-mail:1057944663@qq.com

Treatment for Kawasaki disease with no response to venous injection of gamma globulin and analysis of the risk factors

MEI Ling   

  1. Shenyang Children's Hospital，Shenyang 110032，China
  • Online:2017-08-25 Published:2017-12-08

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139

摘要：
目的
对比分析静脉注射丙种球蛋白治疗川崎病无反应性的危险因素，总结治疗经验。
方法
2013年2月至2016年10月沈阳市儿童医院内二科收治川崎病患儿384例，其中典型病例310例，不完全74例。根据对静脉注射丙种球蛋白治疗的反应，将患儿分为敏感组352例和无反应组32例。对于无反应性川崎病，进行2次静脉注射丙种球蛋白治疗，或大剂量冲击激素治疗，抗炎、对症治疗。
结果
无反应性川崎病发生率8.33%（32/384），退热（14.1±1.1）d，治疗2周后白细胞计数、血小板计数、血沉、C反应蛋白均显著下降，其中C反应蛋白仍略高于正常水平（15.3±3.4）mg/L，超声心电图检查出现冠脉扩张8例，未出现心律失常等严重并发症。无反应组热程、血沉、谷丙转氨酶、首次静脉注射丙种球蛋白后发热时间、首次静脉注射丙种球蛋白时间高于敏感组，治疗后血红蛋白水平低于敏感组，差异有统计学意义（P<0.05）；热程成为独立危险因素［OR=1.48，95%CI（2.41～6.17），P<0.001］。
结论
较长时间的发热可能是首次静脉注射丙种球蛋白无反应性的重要原因，需合理应用静脉注射丙种球蛋白，选择恰当的时机用药，做好抗炎退热治疗。

关键词: 川崎病, 丙种球蛋白, 无反应性川崎病, 危险因素, 儿童

Abstract:
Objective
To compare and analyze the risk factors of Kawasaki disease with no response to venous injection of gamma globulin and to summarize the treatment experience.
Methods
A total of 384 cases of Kawasaki disease in children were treated in our hospital from Feb. 2013 to Oct. 2016, including 310 typical cases and 74 incomplete cases. These children were divided into two groups according to their reaction to the treatment of venous injection of gamma globulin: sensitive group (352 cases) and no-response group (32 cases).For these 32 cases, the injection was performed again, or pulse therapy of large dose of hormone was given as an anti-inflammation and expectant treatment.
Results
The incidence rate of no-response Kawasaki disease was 8.33%(32/384);fever was relieved at (14.1±1.1)d; after 2 weeks of treatment, WBC, PLT, ESR and CRP were decreased significantly, but C-reactive protein was still a little higher than normal［(15.3±3.4)mg/L］. Ultrasound ECG revealed 8 cases of coronary dilation, but there was no such complications as arrhythmia. The fever course, ESR, GPT, the fever time after first injection of gamma globulin and the time of first injection of gamma globulin in the no-response group were higher than those in sensitive group, while Hb level after treatment was lower than sensitive group, the difference being statistically significant(P<0.05).Fever course was an independent risk factor［OR=1.48, 95%CI（2.41～6.17）,P<0.001］.
Conclusion
Long time of fever may be an important reason for no-response to first-time venous injection of gamma globulin. Therefore, it is necessary to use venous injection of gamma globulin properly, select an appropriate time for injection and give timely anti-inflammation and antipyretic treatment.

Key words: Kawasaki disease, Gamma globulin, No-response Kawasaki disease, Risk factors, Child