川崎病治疗前发热时间与丙种球蛋白耐药的相关性临床研究

Association between duration of fever before treatment and intravenous immunoglobulin resistance in Kawasaki disease

摘要:

目的 探讨川崎病（Kawasaki disease，KD）患儿丙种球蛋白（intravenous immunoglobulin，IVIG）治疗前发热时间与IVIG耐药的关系。 方法 回顾性收集2018年1月至2020年12月收治KD患儿317例的病例资料，根据IVIG治疗前发热时间分为短热程组（发热时间≤4 d，n=92）和长热程组（发热时间>4 d，n=225），根据是否发生IVIG耐药将每组再分为耐药组和非耐药组。分析比较不同热程耐药组及非耐药组的基线资料及实验室结果，并采用多因素logistic回归分析IVIG耐药的影响因素。 结果 短热程组中IVIG耐药19例（20.7%），并发冠状动脉瘤5例（5.4%）；长热程组中IVIG耐药22例（9.8%），并发冠状动脉瘤19例（8.4%）；短热程组IVIG耐药率明显高于长热程组（P<0.05），而冠状动脉瘤发生率在两组间差异无统计学意义（P>0.05）。短热程组中，耐药患儿治疗前血钠水平低于非耐药患儿，而降钙素原、C反应蛋白及N末端B型利钠肽原水平则明显高于非耐药患儿（P<0.05）。长热程组中，耐药患儿治疗前血钠及肌酸激酶水平低于非耐药患儿（P<0.05）。多因素logistic回归分析显示，血钠水平降低与长热程组KD患儿IVIG耐药有关（P<0.05）。 结论 KD患儿IVIG耐药因IVIG治疗前发热时间不同而异。在治疗前发热时间>4 d的KD患儿中，血钠降低与IVIG耐药具有相关性。

Abstract:

Objective To examine the association between duration of fever before intravenous immunoglobulin (IVIG) treatment and IVIG resistance in children with Kawasaki disease (KD). Methods A retrospective analysis was performed on the medical data of 317 children with KD who were admitted from January 2018 to December 2020. According to the duration of fever before IVIG treatment, they were divided into two groups: short fever duration group (≤4 days) with 92 children and long fever duration group (>4 days) with 225 children. According to the presence or absence of IVIG resistance, each group was further divided into a drug-resistance group and a non-drug-resistance group. Baseline data and laboratory results were compared between groups. A multivariate logistic regression analysis was used to identify the influencing factors for IVIG resistance. Results In the short fever duration group, 19 children (20.7%) had IVIG resistance and 5 children (5.4%) had coronary artery aneurysm, and in the long fever duration group, 22 children (9.8%) had IVIG resistance and 19 children (8.4%) had coronary artery aneurysm, suggesting that the short fever duration group had a significantly higher rate of IVIG resistance than the long fever duration group (P<0.05), while there was no significant difference in the incidence rate of coronary artery aneurysm between the two groups (P>0.05). In the short fever duration group, compared with the children without drug resistance, the children with drug resistance had a significantly lower level of blood sodium and significantly higher levels of procalcitonin, C-reactive protein, and N-terminal B-type natriuretic peptide before treatment (P<0.05). In the long fever duration group, the children with drug resistance had significantly lower levels of blood sodium and creatine kinase before treatment than those without drug resistance (P<0.05). The multivariate logistic regression analysis showed that a reduction in blood sodium level was associated with IVIG resistance in the long fever duration group (P<0.05). Conclusions IVIG resistance in children with KD varies with the duration of fever before treatment. A reduction in blood sodium is associated with IVIG resistance in KD children with a duration of fever of >4 days before treatment.