静脉免疫球蛋白治疗川崎病的临床分析

 目的 观察川崎病（Kawasaki， KD）的临床特征、大量静脉免疫球蛋白（Intravenous Immunoglobulin， IVIG）治疗前后实验室检查的变化以及随访结果。方法 对29例KD患者临床资料、实验室检查和随访结果进行回顾性分析和总结。收集同期住院治疗24例非感染患者作为对照组，记录对照组血液学检查结果，并与KD组进行比较。结果 ①29例KD患者中，IVIG敏感型25例，IVIG无反应型4例；超声心动图结果显示，冠脉正常16例，冠脉扩张（Coronary Artery Dilation， CAD）9例，冠脉瘤（Coronary Artery Aneurism， CAA）4例。②与对照组比较，治疗前KD患者血白细胞（Write Blood Cell， WBC）、中性粒细胞百分比(neutrophilicgranulocyte， N%）明显增高，淋巴细胞百分比（lymphocyte，L%）明显降低，治疗后WBC、N%和L%与对照组比较无显著性差异。③与KD患者治疗前比较，治疗后WBC、N%和 C反应蛋白（C-reactive protein，CRP）明显降低，L%明显升高，血沉（Erythrocyte Sedimentation Rate ，ESR)变化不明显， 血小板（Blood Platelet，PLT）不受治疗影响而逐渐升高。④22例KD患者进行随访，12例冠脉正常者无新发病变，8例CAD完全恢复正常，1例CAA病变加重，1例CAA不完全恢复。结论 大剂量IVIG治疗KD效果满意，WBC、N%、L%和CRP短期内回复正常，可以作为反应急性期病情变化的指标。对IVIG无反应型KD须引起重视，以便及时采取积极有效的治疗措施。

Clinical Analysis of Intravenous Immunoglobulin in the Patients with Kawasaki Disease

OBJECTIVE To study the clinic features， changes of laboratory examination induced by intravenous immunoglobulin (IVIG) and follow-up results of Kawasaki disease (KD). METHODS The clinic information， laboratory examination and follow-up results of 29 KD patients were reviewed. 24 non-infectious patients were assigned into control group， and the laboratory examination result of controls was compared with KD group. RESULTS 25 of 29 KD patients were IVIG responders and 4 were IVIG non-responders. Echocardiography showed 16 cases of normal coronary artery， 9 cases of coronary artery dilation (CAD)， and 4 cases of coronary aneurysm (CAA). Before treatment， WBC and the proportion of neutrophil (N%) in KD group were higher than those of controls， while the proportion of lymphocytes(L%) was lower than that of control group. After treated by IVIG， the WBC， N% and L% returned to the control group level. In KD group， after IVIG treatment， WBC， N% and CRP decreased significantly， L% and PLT increased significantly， ESR had no change. 22 KD patients were followed up. No new impairment occurred in 12 non-coronary artery lesion cases， 8 CAD cases regressed completely， 1 CAA extended， the other CAA regressed incompletely. CONCLUSION IVIG is an effective agent in the treatment of KD， WBC， N%， L% and CRP can be used to reflect conditions change in acute phase of KD. The doctors should pay attention to IVIG non-response KD in order to take active and effective treatment timely.