2021 年第 2 期 第 16 卷

静脉用丙种球蛋白治疗川崎病的时机和临床效果分析

Timing and clinical effect of intravenous immunoglobulin in the treatment of Kawasaki disease

作者：张英谦1郝京霞1李博1赵紫薇2张会敏1陈敬师1

英文作者：Zhang Yingqian1 Hao Jingxia1 Li Bo1 Zhao Ziwei2 Zhang Huimin1 Chen Jingshi1

单位：1河北省儿童医院心内科，石家庄050031；2河北省儿童医院科教处，石家庄050031

英文单位：1Department of Cardiology Hebei Children′s Hospital Shijiazhuang 050031 China; 2Science and Technology Department Hebei Children′s Hospital Shijiazhuang 050031 China

关键词：川崎病；冠状动脉病变；丙种球蛋白；静脉用丙种球蛋白抵抗；炎性因子

英文关键词：Kawasakidisease;Coronaryarteriallesions;Intravenousgammaglobulin;Resistancetointravenousgammaglobulin;Inflammatoryfactors

• 摘要：

• 目的 探讨静脉用丙种球蛋白（IVIG）治疗川崎病的时机和临床效果。方法 收集2016年1月至2019年12月于河北省儿童医院住院的694例川崎病患儿的临床资料进行回顾性分析。根据IVIG开始应用时间将患儿分为发热≤5 d组（24例）、发热6～10 d组（615例）及发热>10 d组（55例），观察不同时机给予IVIG产生IVIG抵抗及合并冠状动脉病变（CAL）的情况。另选取20名正常体检儿童作为健康对照组，比较不同组间及川崎病患儿治疗前后炎性因子与抗炎因子水平。结果 发热≤5 d组IVIG抵抗率高于发热6～10 d组和发热>10 d组［37.5%（9/24）比1.1%（7/615）、1.8%（1/55）］，差异均有统计学意义（均P<0.001）。IVIG抵抗患儿CAL发生率高于IVIG无抵抗患儿［35.3%（6/17）比15.4%（104/677）］，差异有统计学意义（P<0.05）。发热6～10 d组、发热>10 d组肿瘤坏死因子α水平高于健康对照组和发热≤5 d组，差异均有统计学意义（均P<0.05）。IL-6水平发热≤5 d组最高，发热≤5 d组、发热6～10 d组、发热>10 d组均高于健康对照组，发热>10 d组低于发热≤5 d组和发热6～10 d组，差异均有统计学意义（均P<0.05）。IL-10水平发热≤5 d组最高，发热≤5 d组、发热6～10 d组、发热>10 d组均高于健康对照组，差异均有统计学意义（均P<0.05）。川崎病患儿IVIG治疗后IL-6、IL-10水平均低于治疗前［（13.4±1.8）ng/L比（96.3±9.1）ng/L、（4.2±0.4）ng/L比（13.3±1.4）ng/L］，差异均有统计学意义（均P<0.05）。结论 发热5 d内给予IVIG可增加IVIG抵抗，发热6～10 d可能为应用IVIG的最佳时间。

• Objective To investigate the time and clinical effect of intravenous gamma globulin (IVIG) on Kawasaki disease（KD）.Methods The clinical data of 694 children with Kawasaki disease admitted to Hebei Children′s Hospital from January 2016 to December 2019 were analyzed retrospectively. According to the initial administration time of IVIG, the KD children were divided into fever ≤5 d group(24 cases), fever 6-10 d group(615 cases) and fever >10 d group(55 cases). IVIG resistance and the rate of coronary artery lesion(CAL) were observed when IVIG was given at different time. Another 20 healthy children were selected as the healthy control group, and the levels of inflammatory factors and anti-inflammatory factors were compared among different groups before and after treatment. Results  The IVIG resistance rate in fever ≤5 d group was higher than that in fever 6-10 d group and fever >10 d group［37.5%(9/24) vs 1.1%(7/615), 1.8%(1/55)］, the differences were statistically significant(both P<0.001). The incidence of CAL in KD children with IVIG resistance was higher than that without IVIG resistance［35.3%(6/17) vs 15.4%(104/677)］, and the difference was statistically significant(P<0.05). The levels of tumor necrosis factor-α(TNF-α) in fever 6-10 d group and fever >10 d group were higher than those in healthy control group and fever ≤5 d group(all P<0.05). The level of IL-6 was the highest in the fever ≤5 d group; the levels of IL-6 in the fever ≤5 d group, the fever 6-10 d group and the fever >10 d group were higher than those in the healthy control group, and the levels of IL-6 in the fever >10 d group were lower than those in the fever ≤5 d group and the fever 6-10 d group(all P<0.05). The level of IL-10 was the highest in fever ≤5 d group, and the levels in fever ≤5 d group, fever 6-10 d group and fever >10 d group were higher than those in healthy control group(all P<0.05). The levels of IL-6 and IL-10 in children with KD after IVIG treatment were lower than those before treatment［(13.4±1.8)ng/L vs (96.3±9.1)ng/L, (4.2±0.4)ng/L vs (13.3±1.4)ng/L］, and the differences were statistically significant(both P<0.05). Conclusion Giving IVIG within 5 d of fever can increase IVIG resistance,  and 6-10 d of fever may be the best time to use IVIG.