摘要
目的探讨丙种球蛋白无反应型川崎病(Kawasaki disease,KD)的临床特点和治疗,为其预防和治疗提供参考。方法回顾性分析2013年2月—2015年2月杭州市儿童医院收治的158例川崎病患儿临床资料。首次用药有效者为敏感组,无效者为无反应组。对比分析2组患儿的临床表现、实验室检查、心血管并发症、预后等资料以及无反应组的再次治疗情况。结果丙种球蛋白治疗后,敏感者132例(83.54%),无反应者26例(16.46%)。无反应组患儿冠脉损害发生率显著高于敏感组(61.54%比9.09%);临床表现中无反应组患儿颈部淋巴结肿大、皮疹发病率显著高于敏感组(84.62%比64.39%,88.46%比65.15%);无反应组实验室检查中血小板计数(platelet,PLT)、红细胞沉降率(erythrocyte sedimentation rate,ESR)、丙氨酸转氨酶(alanine aminotransferase,ALT)和肌酸激酶同工酶(creatine kinase isoenzyme MB,CK-MB)显著高于敏感组,血红蛋白(hemoglobin,Hgb)显著低于敏感组,差异有统计学意义(P<0.05)。无反应组26例患儿追加丙种球蛋白治疗、糖皮质激素治疗后热退。随访1年,2组患儿恢复良好。结论丙种球蛋白无反应型KD发生率较高,且更易发生冠状动脉损害。颈部触痛性淋巴结肿大(直径>2 cm)、皮疹,血沉、谷丙转氨酶、血小板计数显著升高,血红蛋白降低可能是丙种球蛋白无反应型KD的危险因素。
Objective To investigate clinical characteristics of Kawasaki disease with no responsiveness immunoglobulin therapy therapy, so as to improve its prevention and treatment. Methods We retrospectively reviewed the clinical data of 158 cases of children with Kawasaki disease from February, 2013 to February, 2015, those who were sensitive to initial treatment were assigned as sensitive group, use for invalid without as Non-sensitive group. Analysis of the two groups of children with clinical manifestation, laboratory examination, cardiovascular complications and prognosis etc, and no re- sponse group treatment again. Results After gamma globulin treatment, 132 cases （83.54%） for sensitive people, no re- sponders 26 cases （ 16.46% ）. Non-sensitive group of laboratory examination of PLT, ESR, ALT and CK-MB group was significantly higher than sensitive group, but Hgb significantly below the sensitive group, the difference was statistically significant（P 〈 0.05 ）. Non-sensitive group of 26 cases underwent additiona ivIg treatment, glucocorticoid treatment, tem- perature was normal. Follow-up for a year,two groups of children recovered well. Conclusion High incidence of ivIg no reaction type KD, and coronary artery damage occur more often. Lymph node neck tenderness sex（ 〉 2 cm in diameter）, skin rashes, PLT, ESR and ALT elevations, Hgb reducing, may be a risk factor for ivIg no reaction type KD.
出处
《中华全科医学》
2017年第5期814-816,共3页
Chinese Journal of General Practice
关键词
川崎病
丙种球蛋白无反应
临床特点
Kawasaki disease
Gamma globulin no response
Clinical characteristics
