CAJ | 학술논문

目的探讨不同静脉注射丙种球蛋白(IVIG)应用时间对IVIG无反应性及冠状动脉并发症的影响.方法回顾性总结北京45家医院2000-2004年有IVIG治疗资料的川崎病患儿,按IVIG使用时间分成早期组(病程1～4 d)、常规组(第5～9天)及晚期组(≥10 d)3组.疗效评价参考MG无反应性及急性期(发病1～2周)和亚急性期(发病3～6周)冠状动脉并发症发生率.结果共有1052例(男680例、女372例)患儿纳入研究,年龄2个月～13.8岁,其中早期、常规及晚期组各有108例、763例和181例.早期组IVIG无反应性发生率(28.7%,31/108)显著高于常规组(11.9%,91/763)和晚期组(7.2%,13/181,均P<0.01).早期组和常规组相比,急性期及亚急性期冠脉并发症发生率差异均无统计学意义[17.6%(19/108)比18.3%(140/763),5.9%(4/68)比5.5%(25/452),均P>0.05],晚期组急性期及亚急性冠脉并发症发生率则显著高于早期和常规组[33.7%(61/181)和12.8%(15/117),均P<0.01)].结论川崎病病程1～4 d应用IVIG增加了患儿IVIG无反应性的发生率,发病≥10 d应用则增加了冠脉并发症的发生率,第5～9天可能是最好的IVIG使用时间.
목적 탐토불동정맥주사병충구단백(IVIG)응용시간대IVIG무반응성급관상동맥병발증적영향.방법 회고성총결북경45가의원2000-2004년유IVIG치료자료적천기병환인,안IVIG사용시간분성조기조(병정1～4 d)、상규조(제5～9천)급만기조(≥10 d)3조.료효평개삼고MG무반응성급급성기(발병1～2주)화아급성기(발병3～6주)관상동맥병발증발생솔.결과 공유1052례(남680례、녀372례)환인납입연구,년령2개월～13.8세,기중조기、상규급만기조각유108례、763례화181례.조기조IVIG무반응성발생솔(28.7%,31/108)현저고우상규조(11.9%,91/763)화만기조(7.2%,13/181,균P<0.01).조기조화상규조상비,급성기급아급성기관맥병발증발생솔차이균무통계학의의[17.6%(19/108)비18.3%(140/763),5.9%(4/68)비5.5%(25/452),균P>0.05],만기조급성기급아급성관맥병발증발생솔칙현저고우조기화상규조[33.7%(61/181)화12.8%(15/117),균P<0.01)].결론 천기병병정1～4 d응용IVIG증가료환인IVIG무반응성적발생솔,발병≥10 d응용칙증가료관맥병발증적발생솔,제5～9천가능시최호적IVIG사용시간.
Objective To compare the rates of intravenous gamma globulin (IVIG) non-responder and coronary complication among early, conventional and late IVIG treatment in children with Kawasaki disease (KD). Methods All children with KD and IVIG treatment were retrospectively analyzed at 45 hospitals in Beijing during the 5-year period from 2000 through 2004. The time of IVIG treatment was classified as early (Day 1 -4), conventional (Day 5 -9) and late treatment group (Day 10 or later). The efficacy of IVIG was judged by the rate of IVIG non-responder. Echocardiography was used to assess the coronary complication at acute (1 - 2 weeks after onset) and sub-acute (3 - 6 weeks after onset) stage.Results A total of 1052 patients (680 boys, 372 girls) aged 2 months to 13.8 years were included. They were grouped as early, conventional and late treatment in 108, 763 and 181 children respectively. The rate of IVIG non-responders was higher in early (28.7% ,31/108) as compared with conventional (11.9% ,91/763) and late treatment group (7.2%, 13/181 ,both P <0.01). The incidences of coronary complications were similar in early (17.6% ,19/108 and 5.9% ,4/68) and conventional treatment group (18.3%, 140/ 763 and 5.5% ,25/452), while significantly higher in late treatment group (33.7% ,61/181 and 12.8%,15/117) in acute and sUblacute stages (both P < 0.01). Conclusions IVIG treatment in children with KD for a disease duration of 1 -4 days appeared to increase the rate of IVIG non-responders. Children with IVIG given at Day 10 or later had a higher incidence of acute and sub-acute coronary complications. IVIG given at Day 5 -9 seems to be the best time for IVIG therapy in KD.