大剂量静脉注射丙种球蛋白无反应性川崎病的临床分析

目的 探讨对大剂量静脉注射丙种球蛋白(IVIG)无反应性川崎病的发生率及临床特点,以及再治疗方案的选择.方法 回顾性总结2000年1月至2006年12月入院的KD患儿的临床资料,根据对首次大剂量IVIG有无反应分成IVIG敏感组和无反应组,比较两组的临床特点.结果 诊断为川崎病并接受IVIG治疗患儿222例,其中IVIG敏感者185例,无反应者37例,发生率16.67%(37/222).无反应组接受IVIG治疗时间早,发热时间长,住院时间长,白细胞总数、中性粒细胞比值、CRP明显高于敏感组,而血浆白蛋白明显低于敏感组.IVIG无反应组合并冠状动脉病变14例(37.84%),明显高于IVIG敏感组(15.68%).IVIG无反应组合并噬血细胞综合征2例,多发性冠状动脉瘤及心肌梗死者1例,多脏器功能衰竭死亡1例.对IVIG无反应者的冉治疗,给予IVIG追加疗法,甲基泼尼松龙冲击治疗,泼尼松口服治疗.结论 IVIG无反应性川崎病较IVIG敏感性川崎病更易发生冠状动脉病变和严重并发症;接受IVIG治疗时间、发热时间、中性粒细胞比值、CRP、血浆白蛋白是IVIG无反应的危险因素.对IVIG无反应性川崎病可以用IVIG追加治疗,无效者选用糖皮质激素.

Clinical analysis of Kawasaki disease patients with non-responsiveness to high-dose gamma-globulin therapy

Objectives To investigate the incidence,clinical characteristics and re-treatment plan of high-dose intravenous immunoglobulin(IVIG)non-responsiveness Kawasaki disease(KD).Methods Clinical data of KD patients hospitalized from January 2000 to December 2006 were retrospectively reviewed.All KD patients were divided into two groups,responsiveness group and non-responsiveness group,based on their response to the first high dose IVIG therapy.Results Total 222 KD patients treated with high dose IVIG were include...