2018 年第 4 期 第 13 卷

静脉注射免疫球蛋白无反应性川崎病的危险因素分析

Risk factors of non-response to initial intravenous immunoglobulin in Kawasaki disease

作者：乐园刘桂英赵梓文

英文作者：

单位：100029首都医科大学附属北京安贞医院儿科

英文单位：

关键词：川崎病;静脉注射免疫球蛋白;危险因素

英文关键词：

• 摘要：

• 目的    探讨静脉注射免疫球蛋白（IVIG）无反应性川崎病的危险因素。方法    选择2015年10月至2017年10月在首都医科大学附属北京安贞医院就诊并接受IVIG联合阿司匹林治疗的川崎病患儿100例,根据对初次IVIG后体温变化分为IVIG无反应组(33例)和IVIG有反应组(67例)。比较2组患儿接受治疗前临床表现、实验室指标和心脏超声影像学特征，对IVIG无反应组进行二分类逻辑回归，分析IVIG无反应的影响因素。结果    IVIG无反应组发热总时间长于IVIG有反应组［(10.8±6.6)d比（8.4±2.6）d］，冠状动脉瘤发生率高于IVIG有反应组［9.1%(3/33)比0.0%（0/67）］，IVIG无反应组NT-proBNP、cTnI明显高于IVIG有反应组［(1 349.0±3.2)ng/L比(588.8±2.8)ng/L，(0.17±0.07)μg/L比(0.11±0.07)μg/L］，差异均有统计学意义（均P<0.05）。Logistic回归分析发现血浆NT-proBNP升高(比值比=1.04,95%置信区间:1.02~1.50)、cTnI升高(比值比=1.28,95%置信区间:1.03~1.60)和冠状动脉瘤(比值比=2.09,95%置信区间:1.25~6.50)是IVIG无反应的危险因素（均P<0．05）。结论    川崎病患儿血浆NT-proBNP、cTnI水平和发生冠状动脉瘤为IVIG无反应性川崎病的危险因素。

• Objective    To analyze the risk factors of non-response to initial intravenous immunoglobulin（IVIG） in Kawasaki disease. Methods    Totally 100 children with Kawasaki disease who had IVIG combined with aspirin in Beijing Anzhen Hospital, Capital Medical University were enrolled from October 2015 to October 2017. According to body temperature changes after initial IVIG, the children were divided into non-response group（n＝33） and response group（n＝67）. Clinical manifestations, laboratory indexes and echocardiography results were analyzed. Risk factors of no-response to initial IVIG were analyzed by logistic regression. Results   Fever time in non-response group was significantly longer than that in response group［9.1%(3/33) vs 0.0%（0/67）］（P<0.05）. Incidence rate of coronary aneurysm in non-response group was significantly higher than that in response group［9.1%(3/33) vs 0.0%（0/67）］（P<0.05）. Plasma levels of N-terminal pro-brain natriuretic peptide（NT-proBNP） and cardiac troponin I（cTnI） in non-response group were significantly higher than those in response group［(1 349.0±3.2)ng/L vs (588.8±2.8)ng/L， (0.17±0.07)μg/L vs (0.11±0.07)μg/L］（P<0.05）. Logistic regression showed that NT-proBNP(odds ratio =1.04, 95% confidence interval: 1.02-1.50)， cTnI(odds ratio=1.28, 95% confidence interval: 1.03-1.60) and coronary aneurysm(odds ratio=2.09, 95% confidence interval: 1.25-6.50) were risk factors of non-response to IVIG. Conclusion    Increased plasma levels of NT-proBNP, cTnI and coronary aneurysm are risk factors of non-response to IVIG in Kawasaiki disease.