川崎病静脉内注射丙种球蛋白治疗耐药的危险因素积分的临床意义

目的 探讨川崎病患儿大剂量静脉内注射丙种球蛋白(IVIG)耐药的危险因素积分的临床意义。方法 回顾性分析2009年至2014年收治的256例川崎病患儿的临床资料,通过IVIG耐药的危险因素加权积分,统计分析危险因素加权积分对IVIG疗效及冠状动脉损伤的影响。结果 与IVIG治疗有效的患儿相比,IVIG治疗无效的患儿具有更高的谷草转氨酶(AST)、谷丙转氨酶(ALT)、乳酸脱氢酶(LDH)、总胆红素和C反应蛋白(P均<0.05);相反,IVIG治疗无效的患儿血小板和血钠均降低(P均<0.05);危险因素积分 ≥3更容易发生IVIG治疗无反应(OR=10.470,P < 0.05);并且IVIG耐药的危险因素积分 ≥3的患儿更容易并发冠状动脉损伤(OR=7.941,P=0.003)。结论 IVIG耐药的危险因素加权积分可更好地预测川崎病患儿的IVIG无反应性和并发冠状动脉损伤情况。

Clinical significance of weighting score for risk factors of resistance to intravenous immunoglobulin in Kawasaki disease

Objective To study the clinical significance of weighting score for risk factors of resistance to high-dose intravenous immunoglobulin (IVIG) in children with Kawasaki disease (KD). Methods Clinical data of 256 cases of children with KD from 2009 to 2014 were retrospectively analyzed, and the effect of weighting score for risk factors of resistance to IVIG on IVIG therapy and coronary artery lesions was statistically evaluated. Results Compared with patients sensitive to IVIG therapy, patients resistant to IVIG therapy had significantly higher serum levels of AST, ALT, LDH, STB (serum total bilirubin) and CRP (P < 0.05), but with significantly lower PLT and serum sodium (P < 0.05). Patients with weighting score for risk factors greater than or equal to 3 were more liable to develop resistance to IVIG therapy (OR=10.470, P < 0.05) and complication such as coronary artery lesions (OR=7.941, P=0.003). Conclusion Weighting score for risk factors of resistance to IVIG has advantage to predict nonresponsiveness to IVIG and complication such as coronary artery lesions in KD children.