延迟使用静脉注射免疫球蛋白对川崎病的临床疗效观察

目的探讨延迟静脉注射免疫球蛋白IVIG治疗对川崎病（KD）的临床效果。方法选择2010年1月～2012年9月我院延迟使用IVIG治疗的KD患儿78例记为观察组，同时选择7d内接受IVIG治疗且在性别、年龄、体重与之匹配的患儿78例为对照组。比较两组治疗前后WBC、NEUT、HGb、PLT、AI用、AST、TB和CRP等，并计算改变分数（Fractionalchanges，FC）；同时比较两组治疗前、急性期及恢复期发生冠状动脉病变（CALs）的例数，CALs包括冠状动脉扩张（CAD）和冠状动脉瘤（CAA）。结果治疗前，与对照组比较，观察组不典型川崎病（IKD）的例数、发病至IVIG的时间、NEUT、ALT及CRP明显增高，PIJrr明显降低，差异有统计学意义（P〈0．05）；两组治疗后WBC、NEUT、ALT和CRP的FC差异无统计学意义（P〉O．05）；治疗前、急性期和恢复期，观察组CALs总例数（CAD与CAA之和）均明显高于对照组，差异有统计学意义（P〈0．01，P〈0．05）。结论延迟IVIG治疗与早期IVIG治疗对KD患者免疫系统的调节作用相当，但延迟IVIG治疗与CALs的发生率增高有关。

The study of late intravenous immunoglobulin treatment in patients with Kawasaki disease

Objective To investigate the effect of late intravenous immunoglobulin treatment in patients with Kawasaki disease. Methods Seventy-eight patients with KD, who were treated with late IVIG treatment （on days 11 to 20 after onset）, were assigned to the observational group. Then 78 pair-matched controls with same gender and age, who received IVIG treat- ment within 8 days after onset were enrolled into control group. Various laboratory data including WBC, NEUT, HGb, PLT, ALT, AST, TB and CRP of all subjects were analyzed before and after IVIG treatment, and the fractional changes（FC） of these parameters were measured by the formula （Y-X）,rX, in which X represents the data before treatment and Y the data after treat- ment. The incidence of coronary artery lesions（CALs） were compared between 2 groups at baseline, acute phase, and convales- cent phase. Results The proportion of incomplete KD（IKD）, serum level of WBC, NEUT, HGb, PLT, ALT, AST, TB and CRP were higher whereas PLT were lower in the observational group at the baseline （P〈0.05）. The FC of WBC, NEUT, ALT and CRP were similar in 2 groups （P〉0.05）. The rate of CALs were significantly higher in the observational group at baseline, acute phase and convalescent phase （P〈0.01 ,P〈0.05）. Conclusion Late IVIG treatment characterize a similar regulation function on immune system, but it may be related with the increased rate of CALs. [