两种方法静脉注射丙种球蛋白治疗川崎病的疗效观察

目的探讨两种方法静脉注射丙种球蛋白（IVIG）治疗川崎病的临床效果。方法将81例川崎病患儿随机分为对照组（n=40）和观察组（n=41）。对照组采用IVIG 0.4 g/（kg.d）静脉注射,5 d 1个疗程;观察组采用IVIG 1.0 g/（kg.d）静脉注射,2 d 1个疗程。2组同时给予阿斯匹林抗凝治疗。观察2组患儿住院时间,黏膜充血、手足肿胀、颈淋巴结肿大消退时间,总热程及退热时间,对2组患儿血清C反应蛋白（CRP）、血沉（ESR）、外周血白细胞计数（WBC）、血小板计数（PLT）变化,冠状动脉扩张（CAD）发生情况及恢复情况进行比较。结果2组治疗后CRP、ESR、WBC、PLT的变化与治疗前比较均显著降低（均P〈0.01）;观察组治疗后的CRP、ESR与对照组比较差异有统计学意义（P〈0.05）;观察组住院时间、总热程及退热时间均低于对照组（均P〈0.05）;2组治疗前后CAD发生情况、CAD恢复正常情况及不良反应比较差异均无统计学意义（均P〉0.05）。结论2种方法静脉注射IVIG治疗川崎病患儿均可有效缓解临床症状,降低CAD发生率,并使CAD尽快得到恢复。观察组在发热、CRP、ESR 3项指标的控制效果方面均显著优于对照组,且退热时间快,总热程短,住院时间少。     

丙种球蛋白联合阿司匹林对川崎病患儿炎症指标及退热时间的影响

目的 探讨川崎病患儿采用丙种球蛋白与阿司匹林联合治疗对炎症指标及退热时间的影响。方法 选取2019年7月至2021年12月信阳职业技术学院附属医院收治的85例川崎病患儿为研究对象,采用掷硬币法将其分为对照组与观察组,对照组42例给予常规治疗+丙种球蛋白治疗,观察组43例给予常规治疗+丙种球蛋白+阿司匹林治疗。两组均连续治疗8周,观察两组临床疗效,比较两组治疗前后炎症指标,记录两组退热时间。结果 观察组临床治疗总有效率(95.35%,41/43)高于对照组(78.57%,33/42),差异有统计学意义(P <0.05);治疗8周后,观察组C-反应蛋白(CRP)[(21.57±5.16) mg/L]、白细胞介素-6[(7.85±2.28) ng/L]、肿瘤坏死因子-α[(9.72±2.35) ng/L]水平低于对照组[(33.49±6.32) mg/L、(19.53±4.06) ng/L、(15.84±3.53) ng/L],差异有统计学意义(P <0.05);观察组退热时间短于对照组,差异有统计学意义(P <0.05)。结论 川崎病患儿采用丙种球蛋白与阿司匹林协同治疗效...     

静注丙种球蛋白预防川崎病冠状动脉损害的疗效观察

静注丙种球蛋白预防川崎病冠状动脉损害的疗效观察５１５０４１汕头大学医学院附属一院马廉华西医科大学小儿血液肿瘤研究室罗春华廖清奎符仁义川崎病是导致儿童继发性心脏病最常见的原因之一。为探讨静注丙种球蛋白（ＩＶＩＧ）对川崎病急性期冠状动脉损害的预防作用，笔...     

川崎病患儿使用丙种球蛋白的临床观察及护理

目的：探讨川崎病（KD）患儿应用丙种球蛋白（工VIG）治疗的必要性和IVIG治疗对KD的影响及其应用IVIO的护理。方法：研究对象为2000～2005年珠海市人民医院儿科收治的42例KD患儿，所有患儿均为10天内退热后确诊且无冠脉病变。将其分2组，治疗组（30例）使用丙种球蛋白，常规组（12例）未使用，余治疗相同。对其冠状动脉损害（CAL）情况进行对比。结果：治疗组与常规组比较，随访0．5年后CAL例数治疗组无1例，常规组2例（16%），治疗组与常规组比较差异有显著性意义（P〈0．01）。结论：应用IVIG治疗KD可以得到满意的效果极其IVIG的护理要点。     

丙种球蛋白联合阿司匹林治疗川崎病患儿的临床效果及对炎性因子水平的影响

目的探讨丙种球蛋白联合阿司匹林治疗川崎病患儿的临床效果及对炎性因子水平的影响。方法选取我院诊断为川崎病患儿62例,按随机数字表法分为对照组(阿司匹林治疗,30例),观察组(丙种球蛋白联合阿司匹林治疗,32例)。比较两组临床疗效、临床症状(颈淋巴结肿大消退时间、四肢症状改善时间、结膜充血消退时间、退热时间、皮疹消退时间)改善情况、血清炎性因子水平(CRP、TNF-α、IL-6、ESR)及不良反应。结果观察组临床疗效明显优于对照组(P0.05);观察组颈淋巴结肿大消退时间、四肢症状改善时间、结膜充血消退时间、退热时间、皮疹消退时间较对照组明显缩短(P0.05);治疗后,两组CRP、TNF-α、IL-6、ESR水平较治疗前均下降(P0.05);且观察组CRP、TNF-α、IL-6、ESR水平较对照组下降更明显(P0.05);两组间冠状动脉病变及不良反应比较无差别(P0.05)。结论丙种球蛋白联合阿司匹林治疗川崎病患儿能提高临床疗效,改善患儿临床症状,同时能降低炎性因子水平,且安全性好。     

丙种球蛋白冲击治疗川崎病的护理

川崎病又名皮肤粘膜淋巴结综合征,最有效的治疗方法是采用丙种球蛋白静脉滴注。本文对８９例川崎病住院患儿采用单次冲击疗法,在退热和预防冠状动脉损害等方面疗效更佳。配合用药前的准备,用药中的观察护理等措施,８９例患儿无任何不良反应及并发症的发生,治愈、好转出院。     

静注丙种球蛋白在小儿全身炎症反应综合征中的观察

目的：观察静脉注射丙种球蛋白（IVIG）对全身炎症反应综合征（SIRS）患儿的临床疗效和免疫球蛋白（Ig）变化。方法：将62例全身炎症反应综合征患儿分成两组，两组均采用综合治疗。观察组加用IVIG，按每次500－1000mg/kg给予，仅用1次。应用前后观察临床疗效并测定免疫球蛋白。结果：观察组临床总有效率明显优于对照组（P＜0.05），且IgG明显升高（P＜0.01）。结论：IVIG治疗SIRS临床疗效确切并可调节免疫机制，改善预后，且安全，可作为佐治SIRS的主要药物。     

静脉注射丙种球蛋白治疗小儿川崎病不良反应观察与护理

目的:通过观察大剂量静脉注射丙种球蛋白(intravenous gamma globulin,IVGG)治疗小儿川崎病的不良反应,探讨输注过程中有效降低不良反应的护理措施。方法:回顾性分析78例川崎病患儿进行大剂量丙种球蛋白静脉输注过程中的不良反应。结果:接受治疗的78例患儿出现过敏性休克1例,寒战10例,高热8例,全身皮疹4例,胸闷气急6例,头痛头昏2例。结论:充分了解药物的性质,掌握正确的输注方法,密切观察输注过程,及时发现并处理各种不良反应是避免、减少并发症发生不可缺少的环节。     

丙种球蛋白无反应型川崎病的631例临床分析

目的总结631例丙种球蛋白无反应型川崎病的临床影像学特点及合并其他病原学感染情况。方法选取自2011年9月至2013年12月收治的起病10 d内接受静脉用丙种球蛋白(IVIG)治疗的631例川崎病患儿为研究对象。初治有效者为敏感组,无效者为无反应组。对两组患儿合并不同病原感染的发生率,影像学特点进行统计分析。结果 1631例患儿中丙种球蛋白治疗敏感者591例,丙种球蛋白治疗无反应者40例,丙种球蛋白无反应型川崎病的发生率为6.34%。2丙种球蛋白无反应组与敏感组相比,无反应组合并支原体感染、腹腔积液和冠脉扩张的发生率均明显高于敏感组(P0.05)。40例无反应KD患儿再次治疗的过程中,11例同意继续追加IVIG 2 g/kg治疗,另外的29例接受激素治疗,发热现象消失。3丙种球蛋白无反应者追加IVIG治疗和激素治疗的两组之间冠脉病变发生率无统计学差异。结论 IVIG无反应型的川崎病发生率约6.34%,并发支原体感染、出现腹腔积液以及出现冠脉扩张的发生率等较高。丙种球蛋白无反应组的再次治疗选择中,激素治疗和追加IVIG治疗均有效。     

Nomogram to predict risk of resistance to intravenous immunoglobulin in children hospitalized with Kawasaki disease in Eastern China

ObjectiveWe aimed to develop a nomogram to predict risk of resistance to intravenous immunoglobulin (IVIG) in children with Kawasaki disease in eastern China.MethodsWe retrospectively analysed the data of children with Kawasaki disease who received IVIG during hospitalisation at Soochow University Affiliated Children’s Hospital. IVIG resistance was defined as recrudescent or persistent fever ≥36 h after the end of the IVIG infusion. Baseline variables were analysed using least absolute shrinkage and selection operator (LASSO) to identify the predictors of IVIG resistance, which were then used to construct a predictive nomogram. Calibration curve and area under the receiver operating characteristic curve (AUC) were used to evaluate the performance of the model. The predictive nomogram was validated on test sets of external data and prospective data.ResultsBetween January 2015 and December 2020, 1293 Kawasaki disease patients were hospitalized in Soochow University Affiliated Children’s Hospital. Among them, 72 (5.57%) showed IVIG resistance. LASSO identified haemoglobin, percentage of neutrophils, C-reactive protein level, platelet count, serum albumin, serum sodium, serum alkaline phosphatase, coronary artery damage, and complete Kawasaki disease as risk factors for IVIG resistance. The nomogram constructed using these factors showed satisfactory discriminatory power (AUC, 0.75), and sensitivity (0.74) and specificity (0.64). In the external data and prospective data, the AUC was 0.66 and 0.83, respectively, the sensitivity was 0.86 and 1, respectively, and the specificity was 0.49 and 0.60, respectively.ConclusionsThe predictive nomogram constructed using nine factors associated with IVIG resistance in children with Kawasaki disease could be a useful tool for identifying patients likely to show IVIG resistance. This nomogram may help reduce the risk of coronary artery lesions.

Key Messages

1. None of the IVIG resistance scoring systems has shown consistently good performance in previous studies. Tools to predict the risk of IVIG resistance in eastern China are lacking.
2. In our series, haemoglobin level, percentage of neutrophils, platelet count, coronary artery damage, incomplete Kawasaki disease, and CRP, serum albumin, serum sodium, and serum alkaline phosphatase levels were risk factors of IVIG resistance in hospitalized children in the eastern China cities of Suzhou and Fuzhou.
3. We propose an easy-to-use nomogram to predict the risk factors of IVIG resistance in hospitalized children.

     

维生素E干预对静脉补铁慢性肾脏病大鼠氧化应激的影响

目的观察维生素E干预对静脉补铁慢性肾脏病(CKD)大鼠氧化应激的影响,为CKD静脉补铁治疗时进行营养干预,改善机体氧化应激状态提供实验依据。方法采用腺嘌呤灌胃方法建立大鼠CKD模型后,给予一次性尾静脉注射铁剂,同时给予维生素E干预2周,观察血浆GSH、维生素E、NO、MDA含量的变化。结果肾病对照组与正常对照组血浆GSH、维生素E、MDA均有显著性差异(P<0.05);肾病补铁组血浆GSH、维生素E低于正常对照组,血浆MDA高于肾病对照组(P<0.05);肾病补铁维生素E干预组与肾病补铁组血浆GSH、维生素E、NO、MDA均有显著性差异(P<0.05)。结论维生素E干预可提高CKD静脉补铁大鼠抗氧化能力,对缓解其体内氧化应激有重要作用。     

静脉滴注免疫球蛋白对川崎病患儿细胞免疫功能的影响

目的　探讨静脉滴注免疫球蛋白 (IVIG)对川崎病患儿细胞免疫 (红细胞免疫及T细胞亚群 )功能的影响及其预防冠状动脉损害的作用机理。方法　T细胞亚群采用S P一步法 ,红细胞免疫活性及其调节因子测定用刘景田法。测定 37例川崎病患儿急性期及恢复期细胞免疫功能的变化。结果　川崎病患儿急性期红细胞C3b受体花环率 (RBC·C3bRR)下降 ,免疫复合物花环率 (ICRR)升高 ,促进因子 (E)活性降低 ,抑制因子 (I)升高 ,E/I降低 ,CD3、CD4下降 ,CD8升高 ,CD4 /CD8下降 ,与对照组比较有显著差异 (P <0 .0 1 )。经IVIG治疗后RBC·C3bR、促进因子 (E)回升 ,ICRR抑制因子 (I)下降 ,CD3、CD4回升 ,CD8下降 ,CD4 /CD8回升 ,临床症状明显改善。结论　细胞免疫功能改变参与了川崎病的发病 ,IVIG可能与提供抗体抑制免疫反应 ,减少血管炎症反应有关 ,IVIG能改善川崎病急性期炎症及预防冠状动脉损害     

Delayed intravenous immunoglobulin treatment increased the risk of coronary artery lesions in children with Kawasaki disease at different status

Objective: Kawasaki disease (KD) is a systemic vasculitis with serious complications, especially the development of coronary artery lesions (CALs). The aim of this study was to identify the risk for the development of CALs with IVIG treatment of KD >10 days after illness onset in patients with different KD status, and explore potential moderators of the association between delayed treatment and CALs.

Methods: We performed a retrospective review of the medical records of KD patients. All patients were divided into two groups (conventional therapy group and delayed therapy group, IVIG treatment ≤10 days vs >10 days). We compared the demographic and clinical characteristics, laboratory data, and analyzed risk factors for CALs in patients who received IVIG treatment >10 days, and determined whether different status of KD modified the effects of delayed IVIG treatment on CALs.

Results: In the delayed IVIG treatment group, children were more likely to develop CALs and the proportion of incomplete KD was higher, compared with the conventional therapy group. The number of children younger than 12 months or older than 61 months was higher and children had higher BMI and were more likely to receive steroids before diagnosis in the delayed IVIG treatment group compared with the conventional therapy group. Delayed IVIG treatment was an independent risk factor for the development of CALs (adjusted OR = 2.90, 95%CI = 1.42, 5.91). Delayed therapy children with higher levels of C-reactive protein (>79 mg/L) and erythrocyte sedimentation rate (>34 mm/h) had the highest risk for developing CALs (OR = 5.68, 95%CI: 1.17, 27.59; OR = 4.11, 95%CI: 1.62, 10.46, respectively).

Conclusion: Delayed IVIG treatment was an independent risk factor for the development of CALs. Children in the delayed IVIG treatment group with higher levels of CRP and ESR (CRP >79 mg/L, ESR >34 mm/h) had the greatest likelihood of developing CALs.     

静脉注射丙种球蛋白改善小儿重症手足口病炎性因子水平的作用

目的探讨静脉注射丙种球蛋白(IVIG)改善小儿重症手足口病(HFMD)炎性因子水平的作用。方法采用回顾性分析法,选取该院收治的120例重症HFMD患儿的临床资料,将患儿分为常规治疗组(n=60)和IVIG组(n=60)。常规治疗组患儿给予一般治疗和对症治疗,IVIG组患儿在常规治疗组治疗方案的基础上增加IVIG治疗。比较治疗前后患儿炎性细胞因子变化情况。同时选取60例健康体检儿童作为对照组。结果治疗前,常规治疗组和IVIG组患儿TNF-α、CRP和IL-6水平较对照组明显升高,差异有统计学意义(P0.05);IVIG组与常规治疗组TNF-α、CRP和IL-6水平差异无统计学意义(P0.05)。治疗后,IVIG组较常规治疗组TNF-α、CRP和IL-6水平有明显下降(P0.05)。结论对于重症HFMD患儿静脉注射IVIG能够有效减少TNF-α、IL-6等炎性因子的生成,促进患儿康复。     

静注人免疫球蛋白对EV71型感染重症手足口病患儿炎症因子、免疫功能的影响

目的探究静注人免疫球蛋白联合常规治疗肠道病毒71（EV71）型感染重症手足口病患儿疗效及对炎症因子、免疫功能的影响。 方法选择2018年12月至2020年12月在海南省妇女儿童医学中心进行治疗的EV71型感染重症手足口病患儿126例,采用随机数字表法分为对照组和观察组,每组各63例。对照组进行常规治疗,观察组在对照组的基础上进行静注人免疫球蛋白治疗。对比2组治疗有效率、临床症状改善时间、血清炎症因子［C反应蛋白（CRP）、白介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）、白介素-17（IL-17）、白介素-10（IL-10）、生长转化因子β₁（TGF-β₁）］及外周血T淋巴细胞亚群水平,并观察记录不良反应发生情况。 结果观察组临床总有效率为87.30%,高于对照组的69.84%（P＜0.05）;观察组体温复常时间、皮疹及口腔溃疡消退时间均短于对照组（P＜0.05）;治疗后,观察组血清CRP、IL-6、TNF-α、IL-17水平低于对照组（P＜0.05）;治疗后,观察组IL-10、TGF-β₁水平高于对照组（P＜0.05）;治疗后,观察组CD3⁺、CD4⁺、CD4⁺/CD8⁺水平高于对照组,CD8⁺水平低于对照组（P＜0.05）;2组患儿在治疗期间未出现药物不良反应。 结论静注人免疫球蛋白联合常规治疗EV71型感染重症手足口病患儿具有较高的临床疗效,能够促进症状恢复,可能与降低炎症反应、提高免疫功能相关。     

Effect of vitamin D on oxidative stress and serum inflammatory factors in the patients with type 2 diabetes

The type 2 diabetes mellitus (T2DM) is an urgent global health problem. T2DM patients are in a state of high oxidative stress and inflammation. Vitamin D and glutathione (GSH) play crucial roles in antioxidation and anti‐inflammation. However, T2DM patients have lower vitamin D and GSH levels than healthy persons. A randomized controlled trial was conducted to see the effect of the vitamin D supplementation on oxidative stress and inflammatory factors in T2DM patients. In this study, a total of 178 T2DM patients were randomly enrolled, 92 patients received regular treatment (T2DM group) and 86 patients in Vitamin D group received extra vitamin D 400 IU per day in addition to regular treatment. Serum vitamin D, GSH, GSH metabolic enzyme GCLC and GR, inflammatory factor MCP‐1, and IL‐8 levels were investigated. We found that the T2DM group has significantly higher concentrations of MCP‐1 and IL‐8 than those in the healthy donor group. After vitamin D supplementation for 90 days, T2DM patients had a 2‐fold increase of GSH levels, from 2.72 ± 0.84 to 5.76 ± 3.19 μmol/ml, the concentration of MCP‐1 decreased from 51.11 ± 20.86 to 25.42 ± 13.06 pg/ml, and IL‐8 also decreased from 38.21 ± 21.76 to 16.05 ± 8.99 pg/ml. In conclusion, our study demonstrated that vitamin D could regulate the production of GSH, thereby reducing the serum levels of MCP‐1 and IL‐8, alleviating oxidative stress and inflammation, providing evidence of the necessity and feasibility of adjuvant vitamin D treatment among patients with T2DM. On the other hand, vitamin D and GSH levels have important diagnostic and prognostic values in T2DM patients.     

大剂量静脉滴注丙种球蛋白防止川崎病患儿冠伏动脉损害的效果评价及护理

目的 探讨大剂量静脉滴注丙种球蛋白防止川崎病患儿冠状动脉损害的效果.方法 将82例川崎病患儿依据治疗方法分为观察组和对照组各41例,观察组患儿采用大剂量丙种球蛋白冲击治疗,对照组应用常规用量进行治疗.对照组采取常规护理,观察组在对照组的基础上按症状实施针对性的护理措施.比较2组的治疗及护理效果.结果 观察组发生冠状动脉扩张1例,对照组发生8例,观察组发生率显著低于对照组.主要观察指标如发热、淋巴结肿大及皮肤黏膜改变的恢复时间观察组明显较对照组缩短.结论 良好细致的护理和健康教育指导,可增加患儿及家属对川崎病的了解,积极配合医疗各个环节,可减少并发症,加快疾病康复.