激素在靜脈丙種球蛋白無反應(yīng)川崎病中的應(yīng)用研究
發(fā)布時間：2018-10-16 12:02
【摘要】：目的探討激素對靜脈丙種球蛋白(Intravenous immunoglobulin,IVIG)無反應(yīng)川崎病(Kawasaki disease,KD)患兒的治療價值。方法收集143例初次IVIG無反應(yīng)川崎病患兒臨床資料,將研究對象分為3組:再次IVIG組(107例)、激素組(口服或者靜滴激素者12例)、再次IVIG+激素組(再次IVIG使用后臨床癥狀仍不緩解加用口服或者靜滴激素者24例)。收集3組患兒臨床資料進行回顧性分析并對其心臟超聲進行隨訪。為進一步探究激素使用方式對急性期治療效果及冠狀動脈的遠(yuǎn)期影響,將激素組、再次IVIG+激素組按激素治療方式分為口服激素組和靜滴序貫口服激素組,并對兩組資料進行統(tǒng)計學(xué)分析。結(jié)果1.再次IVIG組、激素組、再次IVIG+激素組比較:再次IVIG組與再次IVIG+激素組比較:兩組在熱退時間、降低中性粒細(xì)胞百分比(N%)、急性期冠脈擴張的發(fā)生率均無統(tǒng)計學(xué)差異(P0.05);再次ivig組在縮短總熱程、降低白細(xì)胞(wbc)水平優(yōu)于再次ivig+激素組(p=0.015);降低c-反應(yīng)蛋白(crp)水平弱于再次ivig+激素組(p=0.032);兩組血小板(plt)均增高,再次ivig組增高幅度低于再次ivig+激素組(p=0.029);急性期冠脈瘤發(fā)生率、半年時冠脈擴張發(fā)生率低于再次ivig+激素組(p0.05);但兩組在1年后冠脈病變發(fā)生率并無差異(p0.05)。再次ivig組與激素組比較:在熱退時間、降低n%及crp水平、增加plt水平、對急性期冠脈瘤發(fā)生率及冠脈遠(yuǎn)期影響均無統(tǒng)計學(xué)差異(p0.05);在縮短總熱程、降低wbc水平優(yōu)于激素組(p0.05),急性期冠脈擴張發(fā)生率高于激素組(52.8%vs16.7%,p=0.029)。激素組與再次ivig+激素組比較:在總熱程、熱退時間、升高wbc、降低n%等方面無統(tǒng)計學(xué)差異(p0.05);再次ivig+激素組中crp顯著降低、plt顯著升高(p0.05);治療后1周內(nèi)冠脈病變發(fā)生率激素組低于再次ivig+激素組(p0.05);但兩者半年后冠脈病變發(fā)生率均無統(tǒng)計學(xué)差異。2.口服激素組與靜滴序貫口服激素組比較:口服普通劑量潑尼松組與靜滴普通劑量甲強龍序貫口服潑尼松組在總熱程、熱退時間、升高wbc、降低n%和crp水平、急性期及隨訪至1年時冠脈病變發(fā)生率均無統(tǒng)計學(xué)差異(p0.05),但靜滴序貫口服激素組血小板顯著升高,差異有統(tǒng)計學(xué)意義(p=0.010)。結(jié)論本研究提示對初次ivig無反應(yīng)kd患兒直接應(yīng)用激素治療有效,且相對安全,不增加遠(yuǎn)期冠脈病變發(fā)生率;對兩劑IVIG無反應(yīng)后應(yīng)用激素補救治療不影響冠脈遠(yuǎn)期預(yù)后;對IVIG無反應(yīng)KD加用激素治療,選擇普通劑量激素口服或者靜滴序貫口服方式對急性期治療效果及遠(yuǎn)期預(yù)后的影響無顯著差異,但由于靜滴途徑顯著增加血小板水平,導(dǎo)致血栓形成風(fēng)險增高,故口服激素可能是更好的選擇。糖皮質(zhì)激素應(yīng)該作為IVIG無反應(yīng)KD的首選治療或兩次IVIG無反應(yīng)后的補救治療,仍需多中心、隨機、雙盲、大樣本的前瞻性研究。
[Abstract]:Objective to investigate the therapeutic value of hormones in children with intravenous gamma globulin (Intravenous immunoglobulin,IVIG)-inresponsive Kawasaki disease (Kawasaki disease,KD). Methods Clinical data of 143 children with primary IVIG non-reactive Kawasaki disease were collected. The subjects were divided into three groups: IVIG group (107 cases), hormone group (12 cases) and IVIG group (24 cases). The clinical data of 3 groups were analyzed retrospectively and followed up by echocardiography. In order to further explore the long-term effects of hormone use on acute phase therapy and coronary artery, hormone group and IVIG group were divided into oral hormone group and intravenous drip sequential oral hormone group according to hormone therapy. Two groups of data were analyzed statistically. Result 1. Re IVIG group, hormone group, re IVIG hormone group comparison: re IVIG group and re IVIG hormone group comparison: the two groups in the heat receding time, The percentage of neutrophils decreased (N%), the incidence of coronary artery dilatation in acute phase was not significantly different (P0.05). The decrease of leukocyte (wbc) level was better than that of ivig hormone group (p0. 015), the decrease of c-reactive protein (crp) level was weaker than that of re ivig hormone group (p0. 032), the increase of platelet (plt) was higher in both groups, and the increase in ivig group was lower than that in re ivig hormone group (p0. 029). The incidence of coronary artery dilatation was lower in half a year than that in ivig group (p0.05), but there was no difference between the two groups after one year (p0.05). There was no significant difference between the ivig group and the hormone group in the incidence of coronary aneurysm and the long-term effect of coronary artery on the incidence of acute coronary artery aneurysm and the long-term effect of coronary artery in the treatment group (p0. 05), but in shortening the total fever course, there was no significant difference in the incidence of coronary artery aneurysm and the long-term effect of coronary artery in ivig group (p0.05). The incidence of coronary artery dilatation in acute phase was higher than that in hormone group (52.8 vs 16.7p0.029). The hormone group was compared with the ivig hormone group: in the total heat course, the time of heat withdrawal, There was no significant difference in increasing wbc, and decreasing n% (p0.05); crp in ivig group decreased significantly and plt increased significantly (p0.05); the incidence of coronary artery lesion in steroid group was lower than that in ivig group within 1 week after treatment, but the coronary artery lesion occurred half a year after treatment. There was no statistical difference in the rate of birth. 2. Comparison between oral hormone group and sequential oral hormone group: prednisone group and prednisone group were treated with prednisone in the total heat course, the time of heat withdrawal, the increase of wbc, and the decrease of n% and crp levels. There was no significant difference in the incidence of coronary artery lesion in acute phase and follow-up to one year (p0.05), but the platelet level was significantly increased in intravenous drip sequential oral hormone group (p0. 010). Conclusion this study suggests that hormone therapy is effective and relatively safe in primary ivig patients with non-reactive kd, and does not increase the incidence of long-term coronary artery disease, and the long-term prognosis of coronary artery is not affected by hormone therapy after two doses of IVIG. There was no significant difference in the effect of routine oral administration or sequential oral administration of intravenous drip on the efficacy and long-term prognosis of IVIG non-reactive KD, but the platelet level was significantly increased by intravenous drip. Lead to increased risk of thrombosis, so oral hormone may be a better choice. Glucocorticoids should be the preferred treatment for IVIG non-reactive KD or for two IVIG non-reactive remediation. A multicenter, randomized, double-blind, large sample prospective study is still required.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R725.4
本文編號：2274293
[Abstract]:Objective to investigate the therapeutic value of hormones in children with intravenous gamma globulin (Intravenous immunoglobulin,IVIG)-inresponsive Kawasaki disease (Kawasaki disease,KD). Methods Clinical data of 143 children with primary IVIG non-reactive Kawasaki disease were collected. The subjects were divided into three groups: IVIG group (107 cases), hormone group (12 cases) and IVIG group (24 cases). The clinical data of 3 groups were analyzed retrospectively and followed up by echocardiography. In order to further explore the long-term effects of hormone use on acute phase therapy and coronary artery, hormone group and IVIG group were divided into oral hormone group and intravenous drip sequential oral hormone group according to hormone therapy. Two groups of data were analyzed statistically. Result 1. Re IVIG group, hormone group, re IVIG hormone group comparison: re IVIG group and re IVIG hormone group comparison: the two groups in the heat receding time, The percentage of neutrophils decreased (N%), the incidence of coronary artery dilatation in acute phase was not significantly different (P0.05). The decrease of leukocyte (wbc) level was better than that of ivig hormone group (p0. 015), the decrease of c-reactive protein (crp) level was weaker than that of re ivig hormone group (p0. 032), the increase of platelet (plt) was higher in both groups, and the increase in ivig group was lower than that in re ivig hormone group (p0. 029). The incidence of coronary artery dilatation was lower in half a year than that in ivig group (p0.05), but there was no difference between the two groups after one year (p0.05). There was no significant difference between the ivig group and the hormone group in the incidence of coronary aneurysm and the long-term effect of coronary artery on the incidence of acute coronary artery aneurysm and the long-term effect of coronary artery in the treatment group (p0. 05), but in shortening the total fever course, there was no significant difference in the incidence of coronary artery aneurysm and the long-term effect of coronary artery in ivig group (p0.05). The incidence of coronary artery dilatation in acute phase was higher than that in hormone group (52.8 vs 16.7p0.029). The hormone group was compared with the ivig hormone group: in the total heat course, the time of heat withdrawal, There was no significant difference in increasing wbc, and decreasing n% (p0.05); crp in ivig group decreased significantly and plt increased significantly (p0.05); the incidence of coronary artery lesion in steroid group was lower than that in ivig group within 1 week after treatment, but the coronary artery lesion occurred half a year after treatment. There was no statistical difference in the rate of birth. 2. Comparison between oral hormone group and sequential oral hormone group: prednisone group and prednisone group were treated with prednisone in the total heat course, the time of heat withdrawal, the increase of wbc, and the decrease of n% and crp levels. There was no significant difference in the incidence of coronary artery lesion in acute phase and follow-up to one year (p0.05), but the platelet level was significantly increased in intravenous drip sequential oral hormone group (p0. 010). Conclusion this study suggests that hormone therapy is effective and relatively safe in primary ivig patients with non-reactive kd, and does not increase the incidence of long-term coronary artery disease, and the long-term prognosis of coronary artery is not affected by hormone therapy after two doses of IVIG. There was no significant difference in the effect of routine oral administration or sequential oral administration of intravenous drip on the efficacy and long-term prognosis of IVIG non-reactive KD, but the platelet level was significantly increased by intravenous drip. Lead to increased risk of thrombosis, so oral hormone may be a better choice. Glucocorticoids should be the preferred treatment for IVIG non-reactive KD or for two IVIG non-reactive remediation. A multicenter, randomized, double-blind, large sample prospective study is still required.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R725.4
【參考文獻】
相關(guān)期刊論文 前1條
1 趙曉東;杜忠東;;川崎病專題討論會紀(jì)要[J];中華兒科雜志;2007年11期
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