大劑量靜脈丙種球蛋白無反應(yīng)性川崎病危險(xiǎn)因素分析
發(fā)布時(shí)間：2019-03-02 16:46
【摘要】：目的探討大劑量靜脈丙種球蛋白(IVIG)無反應(yīng)性川崎病的發(fā)病率、相關(guān)危險(xiǎn)因素及再治療情況。 方法回顧分析2011.08至2012.08我院住院治療的544例川崎病患兒的臨床資料。根據(jù)對首次大劑量IVIG有無反應(yīng)，將對IVIG治療無效者定為無反應(yīng)組，有效者為敏感組。分析比較兩組患兒的臨床表現(xiàn)、一般情況、實(shí)驗(yàn)室指標(biāo)、超聲心動圖及心電圖等檢查結(jié)果。 結(jié)果544例于起病10天內(nèi)接受IVIG沖擊治療的KD患兒被納入研究對象，，其中無反應(yīng)組54例(9.93%)，敏感組490例(90.07%)。無反應(yīng)組冠脈病變的并發(fā)率與敏感組相近（P0.05)。單因素分析發(fā)現(xiàn)無反應(yīng)組發(fā)熱持續(xù)時(shí)間較敏感組長，眼結(jié)合膜充血發(fā)生率低，淋巴細(xì)胞百分比下降更明顯(p0.05)。Logistic回歸分析發(fā)現(xiàn)發(fā)熱持續(xù)時(shí)間長是IVIG無反應(yīng)性的獨(dú)立危險(xiǎn)因素(P0.05)。無反應(yīng)組出現(xiàn)竇性心動過速及一度房室傳導(dǎo)阻滯的可能性更大(P0.05)。54例無反應(yīng)組患兒中，28例接受了IVIG2g/kg再次沖擊治療，均一次給藥。其中25例患兒治療有效，2例患兒加用糖皮質(zhì)激素治療后體溫恢復(fù)正常，1例加用英夫利西治療后體溫恢復(fù)正常， IVIG再次治療方案有效率為89.2%。25例(43.1%) IVIG無反應(yīng)性KD患兒在首次IVIG治療后3-4d自行退熱。這部分患兒的住院時(shí)間、發(fā)熱持續(xù)時(shí)間、治療后的發(fā)熱時(shí)間明顯短于再次接受IVIG沖擊治療的患兒(P0.05)。且該部分患兒的貧血程度較輕，血小板升高不顯著(P0.05)，冠狀動脈病變發(fā)生率與再次IVIG治療組無明顯差異(P＞0.05)。 結(jié)論該組病例中IVIG無反應(yīng)性川崎病發(fā)生率約9.93%。發(fā)熱持續(xù)時(shí)間長是IVIG無反應(yīng)性的獨(dú)立危險(xiǎn)因素。首次IVIG治療后3-4天內(nèi)自行退熱的IVIG無反應(yīng)性川崎病，對冠脈病變的后期恢復(fù)無明顯影響，臨床上觀察首次IVIG治療后發(fā)熱時(shí)間可適當(dāng)延長。對首劑IVIG無效的KD患兒，推薦予IVIG (2g/kg)再次沖擊治療；仍無效者，可予激素治療。心電圖檢查對早期評估川崎病心臟受累情況有重大意義。
[Abstract]:Objective to investigate the incidence, risk factors and retreatment of high-dose intravenous gamma globulin (IVIG) non-reactive Kawasaki disease (Kawasaki disease). Methods the clinical data of 544 children with Kawasaki disease from 2011.08 to 2012.08 in our hospital were retrospectively analyzed. According to the response to the first large dose of IVIG, the patients who did not respond to IVIG treatment were classified as no-response group and the sensitive group as the effective group. The clinical manifestations, general conditions, laboratory parameters, echocardiography and ECG were analyzed and compared between the two groups. Results 544 children with KD who received IVIG shock therapy within 10 days of onset were included in the study. There were 54 cases (9.93%) in the non-reactive group and 490 cases (90.07%) in the sensitive group. The complication rate of coronary artery lesion in non-reaction group was similar to that in sensitive group (P0.05). Univariate analysis showed that the duration of fever in the non-reactive group was longer than that in the control group, and the incidence of eye-binding membrane congestion was lower. Logistic regression analysis showed that long duration of fever was an independent risk factor for non-reactivity of IVIG (P0.05). In the non-reactive group, sinus tachycardia and one-degree atrioventricular block were more likely to occur (P0.05). Of the 54 non-reactive children, 28 received IVIG2g/kg repulse therapy, all of which were given once. Among them, 25 cases were treated effectively, 2 cases returned to normal after glucocorticoid treatment, and 1 case returned to normal temperature after inflixime treatment, and 2 cases were treated with glucocorticoid, 2 cases were treated with glucocorticoid and 1 case returned to normal temperature. The effective rate of IVIG retherapy was 89.2%. 25 cases (43.1%) of IVIG non-reactive KD were treated with IVIG for 3-4 days. The duration of hospitalization, duration of fever and duration of fever after treatment were significantly shorter than those who received IVIG shock therapy again (P0.05). There was no significant difference in the incidence of coronary artery disease between the two groups (P0.05). There was no significant difference in the incidence of coronary artery disease between the two groups (P > 0.05). Conclusion the incidence of IVIG non-reactive Kawasaki disease in this group is about 9.93%. Long duration of fever is an independent risk factor for non-reactivity of IVIG. IVIG non-reactive Kawasaki disease (Kawasaki disease) with spontaneous antipyretic activity within 3 days after the first IVIG treatment had no significant effect on the late recovery of coronary artery disease. The fever time after the first IVIG treatment could be properly prolonged. IVIG (2g/kg) is recommended for children with KD whose first dose of IVIG is ineffective, and hormone therapy is recommended for those who are still ineffective. ECG examination is of great significance for early assessment of cardiac involvement in Kawasaki disease.
【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】：2013
【分類號】：R725.4
本文編號：2433250
[Abstract]:Objective to investigate the incidence, risk factors and retreatment of high-dose intravenous gamma globulin (IVIG) non-reactive Kawasaki disease (Kawasaki disease). Methods the clinical data of 544 children with Kawasaki disease from 2011.08 to 2012.08 in our hospital were retrospectively analyzed. According to the response to the first large dose of IVIG, the patients who did not respond to IVIG treatment were classified as no-response group and the sensitive group as the effective group. The clinical manifestations, general conditions, laboratory parameters, echocardiography and ECG were analyzed and compared between the two groups. Results 544 children with KD who received IVIG shock therapy within 10 days of onset were included in the study. There were 54 cases (9.93%) in the non-reactive group and 490 cases (90.07%) in the sensitive group. The complication rate of coronary artery lesion in non-reaction group was similar to that in sensitive group (P0.05). Univariate analysis showed that the duration of fever in the non-reactive group was longer than that in the control group, and the incidence of eye-binding membrane congestion was lower. Logistic regression analysis showed that long duration of fever was an independent risk factor for non-reactivity of IVIG (P0.05). In the non-reactive group, sinus tachycardia and one-degree atrioventricular block were more likely to occur (P0.05). Of the 54 non-reactive children, 28 received IVIG2g/kg repulse therapy, all of which were given once. Among them, 25 cases were treated effectively, 2 cases returned to normal after glucocorticoid treatment, and 1 case returned to normal temperature after inflixime treatment, and 2 cases were treated with glucocorticoid, 2 cases were treated with glucocorticoid and 1 case returned to normal temperature. The effective rate of IVIG retherapy was 89.2%. 25 cases (43.1%) of IVIG non-reactive KD were treated with IVIG for 3-4 days. The duration of hospitalization, duration of fever and duration of fever after treatment were significantly shorter than those who received IVIG shock therapy again (P0.05). There was no significant difference in the incidence of coronary artery disease between the two groups (P0.05). There was no significant difference in the incidence of coronary artery disease between the two groups (P > 0.05). Conclusion the incidence of IVIG non-reactive Kawasaki disease in this group is about 9.93%. Long duration of fever is an independent risk factor for non-reactivity of IVIG. IVIG non-reactive Kawasaki disease (Kawasaki disease) with spontaneous antipyretic activity within 3 days after the first IVIG treatment had no significant effect on the late recovery of coronary artery disease. The fever time after the first IVIG treatment could be properly prolonged. IVIG (2g/kg) is recommended for children with KD whose first dose of IVIG is ineffective, and hormone therapy is recommended for those who are still ineffective. ECG examination is of great significance for early assessment of cardiac involvement in Kawasaki disease.
【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】：2013
【分類號】：R725.4
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