CAJ | 학술논문

目的：探讨川崎病患儿采用静脉注射丙种球蛋白（IVIG）治疗发生对治疗无反应性的相关危险因素，为临床早期调整治疗方案提供依据。方法回顾性分析187例川崎病患儿的临床资料，根据 IVIG 治疗的敏感性分为敏感组（160例）和非敏感组（27例），比较两组患儿入院时的基线资料、临床表现差异，并进行Logistic 回归分析筛选相关因素。结果非敏感组患儿的白细胞计数（WBC）、中性粒细胞计数（N）、血红蛋白（Hb）、C 反应蛋白（CRP）、红细胞沉降率（ESR）、白蛋白（Alb）、总胆红素（TB）、免疫球蛋白（IgG）测定值分别为（18．4±5．4）×109／L、（0．72±0．16）×109／L、（99．2±11．3）g／L、（108．4±43．2）mg／L、（75．5±21．8）mm／h、（29．8±3．1）g／L、（21．6±9．3）μmol／L、（11．8±3．4）g／L，敏感组分别为（15．1±4．3）×109／L、（0．62±0.13）×109／L、（109．5±10．4）g／L、（73．5±41．5）mg／L、（55．3±19．4）mm／h、（33．8±3．5）g／L、（12．9±8．8）μmol／L、（7．6±3．5）g／L，两组差异均有统计学意义（t ＝3．548、3．570、4．701、4．018、4．915、5．578、4．713、5.791，均 P ＜0．05）。Logistic 回归分析结果显示：对川崎病患儿采用 IVIG 治疗的无反应性主要前三位危险因素为 ESR （OR ＝2．083）、TB（OR ＝1．632）、CRP（OR ＝1．592），而高 Hb（OR ＝0．743）、Alb（OR ＝0．447）可以降低 IVIG治疗的无反应性风险。结论初诊时较高的 WBC、N、CRP、ESR、TB、IgG 水平可能加大川崎病患儿发生 IVIG治疗的无反应性风险，而高 Hb、Alb 水平有利于降低这一风险因素。
목적：탐토천기병환인채용정맥주사병충구단백（IVIG）치료발생대치료무반응성적상관위험인소，위림상조기조정치료방안제공의거。방법회고성분석187례천기병환인적림상자료，근거 IVIG 치료적민감성분위민감조（160례）화비민감조（27례），비교량조환인입원시적기선자료、림상표현차이，병진행Logistic 회귀분석사선상관인소。결과비민감조환인적백세포계수（WBC）、중성립세포계수（N）、혈홍단백（Hb）、C 반응단백（CRP）、홍세포침강솔（ESR）、백단백（Alb）、총담홍소（TB）、면역구단백（IgG）측정치분별위（18．4±5．4）×109／L、（0．72±0．16）×109／L、（99．2±11．3）g／L、（108．4±43．2）mg／L、（75．5±21．8）mm／h、（29．8±3．1）g／L、（21．6±9．3）μmol／L、（11．8±3．4）g／L，민감조분별위（15．1±4．3）×109／L、（0．62±0.13）×109／L、（109．5±10．4）g／L、（73．5±41．5）mg／L、（55．3±19．4）mm／h、（33．8±3．5）g／L、（12．9±8．8）μmol／L、（7．6±3．5）g／L，량조차이균유통계학의의（t ＝3．548、3．570、4．701、4．018、4．915、5．578、4．713、5.791，균 P ＜0．05）。Logistic 회귀분석결과현시：대천기병환인채용 IVIG 치료적무반응성주요전삼위위험인소위 ESR （OR ＝2．083）、TB（OR ＝1．632）、CRP（OR ＝1．592），이고 Hb（OR ＝0．743）、Alb（OR ＝0．447）가이강저 IVIG치료적무반응성풍험。결론초진시교고적 WBC、N、CRP、ESR、TB、IgG 수평가능가대천기병환인발생 IVIG치료적무반응성풍험，이고 Hb、Alb 수평유리우강저저일풍험인소。
Objective To study treatment has no risk factors associated with response to treatment with intravenous gamma globulin (IVIG)protein in children with Kawasaki disease,so as to provide basis for clinical early treatment scheme.Methods The clinical data of 187 cases of Kawasaki disease in children were retrospective ana-lyzed.Patients were divided into sensitive group (160 cases)and non sensitive group (27 cases)according to the sensitivity of IVIg treatment,differences in baseline data were compared between the two groups of children admitted to hospital.Related factors were screened by clinical manifestations and logistic regression analysis.Results In chil-dren of non sensitive group,white blood cell count (WBC),neutrophil cell count (N),hemoglobin (HB),C -reac-tive protein (CRP),erythrocyte sedimentation rate (ESR),albumin (ALB),total bilirubin (TB)and immunoglo-bulin (IgG)values were determined respectively of (18.4 ±5.4)×109 /L,(0.72 ±0.16)×109 /L,(99.2 ±11.3)g/L, (108.4 ±43.2)mg/L,(75.5 ±21.8)mm/h,(29.8 ±3.1)g/L,(21.6 ±9.3)μmol/L and (11.8 ±3.4)g/L.The data of sensitive group were (15.1 ±4.3)×109 /L,(0.62 ±0.13)×109 /L,(109.5 ±10.4)g/L,(73.5 ± 41.5)mg/L,(55.3 ±19.4)mm/h,(33.8 ±3.5)g/L,(12.9 ±8.8)μmol/L and (7.6 ±3.5)g/L.The difference between the two groups was statistically significant (t =3.548,3.570,4.701,4.018,4.915,5.578,4.713,5.791,all P <0.05).Logistic regression analysis results showed that ESR (OR =2.083),TB (OR =1.632),CRP (OR =1.592)were three main risk factors of IVIG in the treatment of children with Kawasaki disease,and high Hb (OR =0.743),Alb (OR =0.447)could reduce the risk of IVIG treatment.Conclusion In the first visit,higher WBC,N, CRP,ESRTBand IgG levels may increase the reactive risk of IVIG treatment in children with Kawasaki disease.