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目的探讨不同方法丙种球蛋白静脉注射(IVIG)对川崎病患儿疗效及冠状动脉并发症的影响。方法回顾性分析北京45家医院2000—2004年间川崎病患儿的 IVIG 治疗情况,共1052例(男680例、女372例)患儿纳入研究,年龄2月～13.8岁。按 IVIG 给药方法分成2g/kg 单次给药(单次组)、1 g·kg~(-1)·d~(-1)连续2 d(2 d 组)及400～600 mg·kg~(-1)·d~(-1)连续4～5 d(4～5 d 组)3组。观察指标参考 IVIG 无反应性发生率及急性(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。结果单次组、2 d 组和4～5 d组分别有292、656和104例患儿。2 d 组 IVIG 无反应性发生率(61/292,20.9%)显著高于单次组(65/656,9.9%)及4～5 d 组(9/104,8.7%,P<0.01)。急性期冠状动脉并发症、心包积液、二尖瓣反流的发生率3组间差异无统计意义,但亚急性期单次组冠脉并发症(5.1%)及冠状动脉瘤发生率(1.6%)低于4～5 d 组(11.6%和4.7%)和2 d 组(9.8%和5.4%,P=O.035～0.047)。结论 IVIG 2g/kg 单次给药方案可减少冠状动脉并发症和 IVIG 无反应性的发生率,可能是川崎病目前较好的 IVIG 治疗方案。
Objective To investigate the effects of intravenous gamma globulin (IVIG) on efficacy and coronary complications in children with Kawasaki disease. Methods The data of IVIG treatment in children with Kawasaki disease in 45 hospitals in Beijing from 2000 to 2004 were retrospectively analyzed. A total of 1052 children (including 680 males and 372 females) were included in the study, ranging in age from February to 13.8 years. According to the method of IVIG administration, the rats were divided into 2 g / kg single dose group, 1 g · kg -1 d -1 for 2 days and 2 mg to 600 mg kg -1 ~ (-1) · d ~ (-1) for 4 ~ 5 d (4 ~ 5 d) groups. Observations refer to the incidence of IV IV non-responsiveness and the incidence of coronary complications in acute (onset 1-2 weeks) and subacute (3-6 weeks of onset) coronary artery disease. Results There were 292,656 and 104 children in the single group, 2 d group and 4 ~ 5 d group respectively. The incidence of non-responsive IVIG in 2 d group (61 / 292,20.9%) was significantly higher than that in single group (65 / 656,9.9%) and 4 ~ 5 d group (9/104, 8.7%, P <0.01). The incidence of acute coronary complications, pericardial effusion and mitral regurgitation were not statistically different among the three groups. However, the rates of coronary complications (5.1%) and coronary aneurysm %) Were lower than those in 4 to 5 days (11.6% and 4.7%) and 2 days (9.8% and 5.4%, P = 0.035 to 0.047). Conclusions IVIG 2g / kg single dose regimen can reduce the incidence of coronary complications and IVIG non-responsiveness and may be the current good IVIG treatment for Kawasaki disease.