静脉丙种球蛋白治疗川崎病两种剂量的对照研究 |
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引用本文: | 杨晓东,陈秀玉,黄敏,徐萌,黄玉娟,谢利剑,沈捷,王健怡,李锦康,华仰德,杨思源.静脉丙种球蛋白治疗川崎病两种剂量的对照研究[J].临床急诊杂志,2008,9(1):16-18. |
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作者姓名: | 杨晓东 陈秀玉 黄敏 徐萌 黄玉娟 谢利剑 沈捷 王健怡 李锦康 华仰德 杨思源 |
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作者单位: | 上海交通大学附属上海市儿童医院心内科,上海,200040 |
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摘 要: | 目的通过建立两种丙种球蛋白(IVIG)剂量治疗川崎病(KD)的临床对照,探讨一种既适合我国国情,又达到良好疗效的最合理的IVIG剂量。方法随机抽取我院2002年-2006年收治的KD患儿60例病历,根据IVIG治疗情况分为总剂量1g/kg·d^-1单次应用(1g组)和2g/kg(2g组)(包括2g/kg·d^-1单次应用或2g/kg分2次)两组,每组30例,均于发病10d内给予IVIG,两组对比IVIG应用后的退热时间、总热程、C反应蛋白及血沉恢复正常时间,采用SPSS12.0统计软件包进行统计分析。结果两组数据对比后,IVIG应用后的退热时间、总热程、C反应蛋白及血沉恢复正常时间指标P值均〉0.1,不存在统计学差异。用药前1g组有2例出现左侧冠状动脉扩张;2g组有2例左侧冠状动脉扩张,1例双侧冠状动脉扩张,1例表现为双侧冠状动脉管壁增厚毛糙。治疗后两组冠脉损害病例随访2年内冠状动脉均恢复,恢复时间无明显差别;其余病例亦未见异常,但远期冠脉的预后情况正在随访观察中。结论早期给予IVIG治疗KD,可预防冠脉损害,是目前较为理想的治疗方法。本项对照研究提示,临床上采用2g/kg剂量的IVIG治疗KD并不能较1g/kg的剂量更能明显提高临床疗效,反而增加医疗负担,其价值研究有待进一步探讨。但由于本组样本量少,而且有关冠状动脉病变(CAL)的恢复率及预防CAL的发生率2年以上的随访资料正在建立中,故目前认为,IVIG 1g/kg和2g/kg治疗KD的疗效在KD发病后2年内无显著差异。因此,对于确定国内治疗KD合理、经济、有效的最佳IVIG剂量,尚有待于多中心、大样本、长时间,按照循证医学原则进行的前瞻性临床研究加以确定。
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关 键 词: | 川崎病 丙种球蛋白 静脉 |
Case-control Evaluation of Two Modalities with Intravenous γ-immunoglobulin Infusion f Kawasaki Disease |
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Institution: | YANG Xiao-dong, CHEN Xiu-yu,HUANG Min, et al. ( Department of Cardiology, Shanghai Children' s Hospital of Shanghai Jiaotong University, Shanghai 200040, China. ) |
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Abstract: | Objective To discuss the best cost-effective of intravenous γ-immunoglobulin(IVIG) in Kawasaki disease by making a case-control with two modalities IVIG infusion. Methods Randomize 60 KD cases were treated by IVIG in our department from 2002 to 2006 were reviewed. The two modalities were as follows:30 cases in 1 g/kg for one day,30 cases in 2 g/kg treatment (for 1 day or 2 days) ,all were treated IVIG in 10 days of the illness onset. The duration of temperature, C-reaction protein and ESR returned to normal time, the general period of fever were compared. The statistics tools was SPSS 12. 0 system. Results To study the compared datum,no differences between the two modalities in the duration of temperature, C-reaction protein and ESR covery, the general period of fever. For coronary artery lesion (CAL) is still in eval- uation. Conclusions It can prevent CAL that treated by IVIG in the early time. The treatment of 2 g/kg had no much be benaficial effects the once treatment ( 1g/kg,for 1 day) in our randomize trials. But it still not enough large cohort of patient in our studies, we still need muhi-center, large cohort of patient and long time research work to make sure of the best IVIG treatment. |
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Keywords: | Kawasaki disease γ-immunoglobulin Intravenous |
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