273�临床研究�静脉注射丙种球蛋白无反应型川崎病56例临床分析胡坚,张庆,傅松龄,龚方戚,朱卫华,解春红,汪伟摘要目的:分析静脉注射丙种球蛋白(IviG)无反应型川崎病患儿的临床特点�方法:对2(X)7刁1至208扔期间在我院住院治疗的332例川崎病患儿进行病例回顾性分析�结果:WIG无反应型川崎病共56例(占16.9%)�IviG无反应型川崎病中男女性别比为4.09:1,明显高于WIG敏感川崎病1.38:1(尸<0.05)�rVIG无反应型川崎病中有较严重冠状动脉扩张或冠状动脉瘤者n例(19.6%),明显高于WIG敏感川崎病(2.5%)(尸<0.05)�川崎病患儿发生mG耐药的可能危险因素有外周血白细胞�中性粒细胞比例�血红蛋白�红细胞压积�血小板�C反应蛋白�血沉�血浆白蛋白�乳酸脱氢酶等�WIG无反应型川崎病患儿中3例通过复用IVIG后临床症状得以缓解,仅n例在复用WIG后症状仍不能控制而加用激素治疗�结论:WIG无反应型川崎病较IvlG敏感川崎病更易发生冠状动脉病变�复用IVIG及必要时加用激素对WIG无反应型川崎病治疗有较好疗效�关键词川崎病;静脉注射丙种球蛋白无反应;临床特点;治疗Cli川calFeaturesinPatientsWithIutravenoush列Inunoglob加ResistantE渡wasaki肠se别犯HUJian,ZHANGQing,FUSong一ling,GONGFang一单,ZHUWei七ua,XIEChun~hong,WANGWei.DepaI�tmeltOfCardiolo群扩几eChildren�5Hospi回,ZhejiangU垃versitySchoolOfMedieine,H田lgzhou(3l0(刃3),Zhejiang,ChinaCorespon由嗯Author:GONGFang一单,Em苗1:gongfangqi@Zju.edu.enAbstr8Ctobjective:TOinvestigatetheeli苗ealfeaturesandriskfaetorsinpatients衍thinl泊wenousimmunoglobin(IvIG)resistantKa~w二只只kidisease.Methods:AtotalOf332patientswithKawasakidiseasefromJanu呵20(y7toJ叻e以X)8tre川tedinourhosPi妞wereretro-sPeCtivelranalyZed.Result�:Therewere56/332(16.9%)patientsfailedtoinitidWIG晓叻刀朋t.A功Ongthosep.tie刀ts,theratioofm司etofe-malewas4�09:l,thatwas51,ificantl,higherthanIVIGresponsiveKawas山diseasepatients(1.38;l),(P<0.05).The尹tientswithIVIGresistantKawas山diseasehadhigherandseverereoron娜arte可lesions(19.6%)than面�eOfIVIG花spsnsivepatients(2.5%),(p<0.05).ComparedwithIVIGresponsivepatients,the娜sibleriskfactooforWIGresistantK姗aS山dis-easewerewhitebloodeel,neutIDphilratio,hemoglobulin,hematoerit,Plateleteount,C曰沈ac丘,eprotein,e单broc外e�汕mentationrate,山uminandlactatedehydrogenase,etc.Inmalepatienis,decreasedhematoctit助dd亡亡比朋记目山u面n面ghtberelatedtoIVIGresistant.Additionali面sionofIVIGefeetedinmostmGresistantpatients(33/56)声加m五d七�atmentwasusedto11沙tientsinwhomtheadditionalinflisionofIVIGhadnoefeets.Conclusion:几epaticntswithIviGresistantKawaS山diseaseshadthehigharri吸forc.旧训叮时.叮1.加细人d击丘叨习in-加幼onofWIGandsteI�Oldtreatme爪withantiplateletandantico理川antmedicationss玩附�dg耐d介改.血p浦.t.初山p八Gre-515切叮tKaw月,R卜1disea吕e.Keywo川吕K~巍disease;Intravenousi~unoglobinresistance;Cbltic吐几at坦eS;T,时功加t(ChineseC流过如眼Jo切m司,2以为:24:273.)作者单位:31�x!3浙江省杭州市作者简介:胡坚住院医师学士edu.en浙江大学医学院附属儿童医院心血管内科主要从事小儿心血管内科临床工作Email:d山u@live.~中图分类号旧5礴1文献标识码:A文章编号:1(X减冲614(2侧珍)供报73拼翻:10.3969;/j.1.通讯作者:龚方戚Elna让:,�沙叩明i@zju.1�洲劝刁6�4.2以珍.民.010川崎病即皮肤粘膜淋巴结综合征,是儿童常见的一种病因未明的血管炎综合征,大剂量静脉注射丙种球蛋白(IviG)联合阿司匹林是目前治疗川崎病公认的有效方法�文献报道,经过IVIG治疗,仍有部分患JL持续发热或热退后再度发热,称为IviG无反应型川崎病[�](也有IvxG耐药川崎病�IvIG非敏感川崎病�难治型川崎病等多种表述)�本文对IviG无反应型川崎病进行病例回顾性分析,将其与IVIG敏感川崎病进行对比研究以了解其发生的可能危险因素,并探讨其治疗及预...
