再次应用静脉丙种球蛋白无反应川崎病的预测因素分析

目的 探讨再次应用丙种球蛋白（简称丙球）无反应川崎病(KD)的危险因素及预测指标。方法 收集2010年1月至2015年1月在重庆医科大学附属儿童医院收治的初次丙球无反应并接受再次丙球治疗的KD患儿，分为再次丙球有反应组和无反应组，对2组的临床特征及实验室指标进行回顾性分析。结果 81例KD患儿进入分析，再次丙球有反应组占75.3%（61/81），无反应组占24.7%（20/81）。两组性别、年龄、初次丙球治疗前后临床表现和2次丙球使用间隔时间差异均无统计学意义。在初次丙球使用前，冠状动脉病变发生率、血常规（WBC、PLT、Hb、N）、CRP、肝功能、电解质等指标再次丙球有反应组和无反应组差异均无统计学意义。再次丙球治疗前与初次应用丙球前，血常规和CRP指标差值再次丙球有反应组和无反应组差异均无统计学意义。结论 初次丙球使用前的临床表现及实验室指标不能预测初次丙球无反应KD再次应用丙球是否有效，初次应用丙球后的临床表现及血常规、CRP指标对再次应用丙球是否有效亦无提示作用。

Prediction of unresponsiveness to intravenous immunoglobulin retreatment in patients with Kawasaki disease

Objective To investigate the risk factors and prediction of unresponsiveness to intravenous immunoglobulin (IVIG) retreatment in patients with Kawasaki disease(KD).Methods From Jan 2010 to Jan 2015, the clinical and laboratory features of 81KD patients in Children's Hospital of Chongqing Medical University retreated with IVIG were retrospectively analyzed.Results Eighty one KD patients were enrolled. The incidence of IVIG retreatment - responsive group was 75.31% (61/81), while IVIG retreatment - unresponsive group was 24.69% (20/81). There were no statistical differences in the gender, age, the clinical features before or after initial IVIG treatment, the interval of IVIG for two times between two groups. Before initial IVIG, there were no statistical differences in the incidences of coronary artery lesions, laboratory features including WBC, PLT, Hb, N, CRP, ALT, AST and electrolyte between two groups. After initial IVIG treatment, there were no statistical differences in the amplitude of variation in WBC, PLT,N%, Hb and CRP between two groups.Conclusion The clinical manifestations and laboratory features before initial IVIG treatment could not predict the unresponsiveness to IVIG retreatment. Similarly, the clinical manifestations and the peripheral blood cell counts examination after initial IVIG treatment had no prediction for the unresponsiveness to IVIG retreatment.