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目的探讨川崎病(KD)静脉注射丙种球蛋白(IVIG)治疗无反应的危险因素,为及时诊治IVIG治疗无反应病例提供依据。方法选择1993年3月-2010年12月在本院住院治疗的KD患儿219例。患儿均予IVIG治疗,根据患儿对IVIG治疗的反应分为IVIG敏感组和IVIG无反应组。对KD患儿的年龄、性别、主要临床表现、治疗前及治疗24～48 h血常规结果、血生化辅助检查、心脏超声检查结果、治疗过程及疗效进行回顾性分析,并应用SPSS 13.0软件对结果进行统计学分析。结果 IVIG治疗无反应组治疗前中性粒细胞比例、CRP水平及治疗后白细胞水平、中性粒细胞比例、CRP水平均显著高于IVIG敏感组(Pa<0.05);IVIG治疗无反应组血总胆固醇、血钠、血钾水平均显著低于IVIG敏感组(Pa<0.05);上述指标积分≥6的ROC曲线下面积达0.955,预测患儿IVIG无反应的敏感度为95.1%,特异度为80.0%。结论联合应用治疗前中性粒细胞比例、CRP水平,治疗后白细胞水平、中性粒细胞比例、CRP水平、血胆固醇、血钠及血钾水平积分,对于预测IVIG无反应KD病例的发生有较高的价值。
Objective To investigate the risk factors of noninvasive response to intravenous immunoglobulin G (IVIG) in KD patients and provide evidence for the timely diagnosis and treatment of non-responsive IVIG patients. Methods A total of 219 KD children hospitalized in our hospital from March 1993 to December 2010 were selected. Children were treated with IVIG and were divided into IVIG-sensitive group and IVIG non-responsive group according to their response to IVIG treatment. The age, gender, major clinical manifestations, preoperative and 24 ~ 48 h blood routine results, blood biochemical tests, echocardiographic findings, course of treatment and therapeutic efficacy were retrospectively analyzed in children with KD and SPSS 13.0 software was used Results were statistically analyzed. Results The level of neutrophil, CRP, leukocyte level, neutrophil ratio and CRP level in non-responsive group after IVIG treatment were significantly higher than those in IVIG sensitive group (Pa <0.05) Cholesterol, serum sodium, serum potassium levels were significantly lower than the IVIG sensitive group (Pa <0.05); the area under the ROC curve score ≥ 6 0.955, the predictive IVIV non-responsive sensitivity was 95.1%, the specificity was 80.0%. Conclusion The combination of pretreatment neutrophil ratio, CRP level, leukocyte level after treatment, neutrophil ratio, CRP level, blood cholesterol, serum sodium and serum potassium levels are more important for predicting the incidence of unresponsive IVG KD cases High value.