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目的对比分析静脉注射丙种球蛋白治疗川崎病无反应性的危险因素,总结治疗经验。方法2013年2月至2016年10月沈阳市儿童医院内二科收治川崎病患儿384例,其中典型病例310例,不完全74例。根据对静脉注射丙种球蛋白治疗的反应,将患儿分为敏感组352例和无反应组32例。对于无反应性川崎病,进行2次静脉注射丙种球蛋白治疗,或大剂量冲击激素治疗,抗炎、对症治疗。结果无反应性川崎病发生率8.33%(32/384),退热(14.1±1.1)d,治疗2周后白细胞计数、血小板计数、血沉、C反应蛋白均显著下降,其中C反应蛋白仍略高于正常水平(15.3±3.4)mg/L,超声心电图检查出现冠脉扩张8例,未出现心律失常等严重并发症。无反应组热程、血沉、谷丙转氨酶、首次静脉注射丙种球蛋白后发热时间、首次静脉注射丙种球蛋白时间高于敏感组,治疗后血红蛋白水平低于敏感组,差异有统计学意义(P<0.05);热程成为独立危险因素[OR=1.48,95%CI(2.41~6.17),P<0.001]。结论较长时间的发热可能是首次静脉注射丙种球蛋白无反应性的重要原因,需合理应用静脉注射丙种球蛋白,选择恰当的时机用药,做好抗炎退热治疗。
Objective To comparatively analyze the risk factors of non-responsive Kawasaki disease treated with intravenous gamma globulin, and summarize the experience of treatment. Methods From February 2013 to October 2016, 384 children with Kawasaki disease were admitted to Children’s Hospital of Shenyang City, including 310 cases of typical cases and 74 cases of incomplete Kawasaki disease. According to the response to intravenous administration of gamma globulin, the children were divided into a sensitive group of 352 patients and a non-responsive group of 32 patients. For non-reactive Kawasaki disease, 2 intravenous gamma globulin therapy, or high-dose shock hormone therapy, anti-inflammatory, symptomatic treatment. Results The incidence of non-responsive Kawasaki disease was 8.33% (32/384) and was reduced to fever (14.1 ± 1.1) days. The white blood cell count, platelet count, erythrocyte sedimentation rate, and C-reactive protein decreased significantly after 2 weeks of treatment, Higher than the normal level (15.3 ± 3.4) mg / L, echocardiography showed coronary dilation in 8 cases, no serious complications such as arrhythmia. No reaction group heat stroke, ESR, alanine aminotransferase, the first intravenous injection of gamma globulin fever time, the first intravenous gamma globulin time is higher than the sensitive group, the hemoglobin level after treatment is lower than the sensitive group, the difference was statistically significant (P <0.05). Hyperthermia became an independent risk factor [OR = 1.48, 95% CI (2.41 ~ 6.17), P <0.001]. Conclusion Long-term fever may be the first reason for intravenous gamma globulin non-responsiveness. It is necessary to use intravenous gamma globulin rationally and select the appropriate timing for anti-inflammatory and antipyretic treatment.