不同途径给予激素治疗丙种球蛋白无反应型川崎病临床观察
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摘要
目的探讨不同途径给予激素治疗丙种球蛋白(IVIG)无反应型川崎病(KD)患儿的临床疗效及安全性。方法回顾性分析2012年1月—2015年12月收治的IVIG无反应型KD患儿104例的临床及随访资料,根据激素给予途径的不同分为对照组50例和观察组54例,对照组予以静脉滴注序贯口服激素治疗,观察组予以口服激素治疗。治疗结束后比较2组相关医技检查指标水平和总热程、退热时间及住院时间,并记录2组治疗后随访过程中冠状动脉病变及血栓形成情况。结果 2组总热程、退热所需时间以及住院时间比较差异均无统计学意义(P>0. 05)。治疗后2组血小板均较治疗前升高(P <0. 05)。治疗后观察组C反应蛋白水平低于对照组(P <0. 05)。随访期间不同时间段2组冠状动脉扩张和冠状动脉瘤发生率比较差异无统计学意义(P>0. 05)。观察组未发生血栓,对照组发生4例。结论激素治疗IVIG无反应型KD患儿具有良好的近远期效果,但采用口服途径具有更好的安全性。
Objective To investigate clinical efficacy and safety of different ways of hormone therapy in treatment of patients with intravenous immunoglobulin( IVIG) non-responsive Kawasaki disease. Methods Clinical and follow-up data of 104 children with IVIG non-responsive KD admitted during January 2012 and December 2015 was retrospectively analyzed,and the children were divided into control group( n = 50) and observation group( n = 54) according to different ways of hormone therapy. Control group was treated with intravenous and sequential hormonal therapy orally,while observation group was treated with hormonal therapy orally. After treatment,levels of related medical examination indexes,total heat duration,pyretolysis time and hospitalization duration were compared,and conditions of coronary artery lesions and thrombosis during follow-up were recorded in two groups. Results There were no significant differences in total heat duration,pyretolysis time and hospitalization duration between two groups( P > 0. 05). After treatment,platelet( PLT) levels were significantly higher than those before treatment in two groups( P < 0. 05); C-reactive protein( CRP) level in observation group was significantly lower than that in control group( P > 0. 05). During follow-up,there were no statistically significant differences in incidence rates of coronary artery dilatation and coronary artery tumor at different times between two groups( P > 0. 05). There was no thrombus in observation group,and 4 patients had thrombus in control group. Conclusion Hormone therapy in treatment of patients with IVIG non-responsive Kawasaki disease may achieve good short and long-term effect,but oral administration has better safety.
Objective To investigate clinical efficacy and safety of different ways of hormone therapy in treatment of patients with intravenous immunoglobulin( IVIG) non-responsive Kawasaki disease. Methods Clinical and follow-up data of 104 children with IVIG non-responsive KD admitted during January 2012 and December 2015 was retrospectively analyzed,and the children were divided into control group( n = 50) and observation group( n = 54) according to different ways of hormone therapy. Control group was treated with intravenous and sequential hormonal therapy orally,while observation group was treated with hormonal therapy orally. After treatment,levels of related medical examination indexes,total heat duration,pyretolysis time and hospitalization duration were compared,and conditions of coronary artery lesions and thrombosis during follow-up were recorded in two groups. Results There were no significant differences in total heat duration,pyretolysis time and hospitalization duration between two groups( P > 0. 05). After treatment,platelet( PLT) levels were significantly higher than those before treatment in two groups( P < 0. 05); C-reactive protein( CRP) level in observation group was significantly lower than that in control group( P > 0. 05). During follow-up,there were no statistically significant differences in incidence rates of coronary artery dilatation and coronary artery tumor at different times between two groups( P > 0. 05). There was no thrombus in observation group,and 4 patients had thrombus in control group. Conclusion Hormone therapy in treatment of patients with IVIG non-responsive Kawasaki disease may achieve good short and long-term effect,but oral administration has better safety.
引文
[1] Han J W. The Efficacy and Safety of High-Dose Intravenous Immunoglobulin in the Treatment of Kawasaki Disease:How Can We Predict Resistance to Intravenous Immunoglobulin Treatment of Kawasaki Disease?[J]. Korean Circ J,2017,47(2):179-181.
[2]郭翼红,俞海国,张雅媛,等.静脉注射用丙种球蛋白联合糖皮质激素治疗丙种球蛋白无反应型川崎病[J].儿科药学杂志,2016,22(5):9-11.
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[4]杨莹,张静.激素与静脉丙种球蛋白及其联合应用治疗静脉丙种球蛋白无反应川崎病的回顾性对照研究[J].中国循证儿科杂志,2016,11(4):265-269.
[5]陈颖,曾嵘.甲基泼尼松治疗静脉丙种球蛋白无反应型川崎病的疗效观察[J].儿科药学杂志,2016,21(8):17-19.
[6]苑荣亮,崔成成,井敏敏,等.人星状病毒非结构蛋白ns P1a/1表达纯化及多克隆抗体的制备[J].医学分子生物学杂志,2016,13(3):158-162.
[7]王韧健,谢利剑,黄敏.静脉注射丙种球蛋白无反应型川崎病治疗进展[J].临床儿科杂志,2016,34(1):68-72.
[8]李建木.大剂量丙种球蛋白静脉输注治疗川崎病患儿的疗效观察[J].保健医学研究与实践,2016,13(3):34-36,39.
[9]庞婧,席超,张铁梅.肝X受体LXRα对肝细胞内葡萄糖氧化的调节[J].医学分子生物学杂志,2016,38(4):198-202.
[10] Tremoulet A H,Jain S,Kim S,et al. Rationale and study design for a phase I/IIa trial of anakinra in children with Kawasaki disease and early coronary artery abnormalities(the ANAKID trial)[J]. Contemp Clin Trials,2016,48:70-75.
[11]陈咏冰,金红芳.川崎病静脉丙种球蛋白耐药临床判断预测及处理[J].中国实用儿科杂志,2017,32(8):584-588.
[12]沈杨,单晶,刘光辉,等.丙种球蛋白联合阿司匹林肠溶片治疗川崎病的临床研究[J].中国临床药理学杂志,2017,32(23):2347-2350.
[13]崔忠,赵清涛,孙建斌,等.复方苦参注射液对胆胰结合部恶性肿瘤术后化疗患者免疫功能的影响[J].解放军医药杂志,2017,29(4):20-23.
[14]刘洋,周莹,阳韬,等.血清结合珠蛋白在非小细胞肺癌诊治中的意义[J].江苏大学学报:医学版,2017,27(6):530-532.
[15]向龙,陈聪.丙种球蛋白治疗不敏感川崎病的临床探讨[J].检验医学与临床,2016,13(6):826-828.
[16]刘向阳,曹慧芳,古小东.盐酸奥洛他定片治疗过敏性鼻炎的效果及对患者血清免疫球蛋白水平的影响[J].保健医学研究与实践,2017,14(3):64-66.
[17]李晨,施红英,何跃娥,等.谷丙、谷草转氨酶与丙种球蛋白无反应型川崎病相关性的Meta分析[J].浙江医学,2016,38(22):1787-1794.
[18] Nakagama Y,Inuzuka R,Hayashi T,et al. Fever pattern and C-reactive protein predict response to rescue therapy in Kawasaki disease[J]. Pediatrics International,2016,58(3):180-184.
[19]梁雪,金莲花,张胜,等.丙种球蛋白无反应性川崎病的临床特点及危险因素分析[J].中国实验诊断学,2017,21(4):679-681.
[20]张年春,朱建华,罗文峰,等.闭合性骨折创伤患者血浆D-二聚体和纤维蛋白原水平及与创伤程度的相关性研究[J].解放军医药杂志,2017,29(4):82-84.
[21]焦爱萍,秋艳萍,黎建丽,等.双嘧达莫联合阿司匹林、丙种球蛋白治疗川崎病的疗效及其对炎性因子的影响[J].儿科药学杂志,2016,21(9):17-20.
[22]吴自明,张正宇,罗昭旸,等.丙种球蛋白非敏感型川崎病危险因素分析[J].临床儿科杂志,2018,36(1):1-4.
[23]何志萍,吴雅娟,李翠霞,等.丙种球蛋白联合阿司匹林对川崎病合并冠状动脉损伤患者T细胞亚群的影响[J].热带医学杂志,2016,16(4):510-513.
[24] Zhu F H,Ang J Y. The Clinical Diagnosis and Management of Kawasaki Disease:a Review and Update[J].Curr Infect Dis Rep,2016,18(10):32.
[25]赵坚,黄敏,谢利剑,等.联合糖皮质激素初始治疗川崎病的临床分析[J].国际儿科学杂志,2017,44(9):624-626.
[2]郭翼红,俞海国,张雅媛,等.静脉注射用丙种球蛋白联合糖皮质激素治疗丙种球蛋白无反应型川崎病[J].儿科药学杂志,2016,22(5):9-11.
[3]陈妙月,吴素玲,薛功寿.丙种球蛋白无反应型川崎病的临床特点和治疗分析[J].中华全科医学,2017,15(5):814-816.
[4]杨莹,张静.激素与静脉丙种球蛋白及其联合应用治疗静脉丙种球蛋白无反应川崎病的回顾性对照研究[J].中国循证儿科杂志,2016,11(4):265-269.
[5]陈颖,曾嵘.甲基泼尼松治疗静脉丙种球蛋白无反应型川崎病的疗效观察[J].儿科药学杂志,2016,21(8):17-19.
[6]苑荣亮,崔成成,井敏敏,等.人星状病毒非结构蛋白ns P1a/1表达纯化及多克隆抗体的制备[J].医学分子生物学杂志,2016,13(3):158-162.
[7]王韧健,谢利剑,黄敏.静脉注射丙种球蛋白无反应型川崎病治疗进展[J].临床儿科杂志,2016,34(1):68-72.
[8]李建木.大剂量丙种球蛋白静脉输注治疗川崎病患儿的疗效观察[J].保健医学研究与实践,2016,13(3):34-36,39.
[9]庞婧,席超,张铁梅.肝X受体LXRα对肝细胞内葡萄糖氧化的调节[J].医学分子生物学杂志,2016,38(4):198-202.
[10] Tremoulet A H,Jain S,Kim S,et al. Rationale and study design for a phase I/IIa trial of anakinra in children with Kawasaki disease and early coronary artery abnormalities(the ANAKID trial)[J]. Contemp Clin Trials,2016,48:70-75.
[11]陈咏冰,金红芳.川崎病静脉丙种球蛋白耐药临床判断预测及处理[J].中国实用儿科杂志,2017,32(8):584-588.
[12]沈杨,单晶,刘光辉,等.丙种球蛋白联合阿司匹林肠溶片治疗川崎病的临床研究[J].中国临床药理学杂志,2017,32(23):2347-2350.
[13]崔忠,赵清涛,孙建斌,等.复方苦参注射液对胆胰结合部恶性肿瘤术后化疗患者免疫功能的影响[J].解放军医药杂志,2017,29(4):20-23.
[14]刘洋,周莹,阳韬,等.血清结合珠蛋白在非小细胞肺癌诊治中的意义[J].江苏大学学报:医学版,2017,27(6):530-532.
[15]向龙,陈聪.丙种球蛋白治疗不敏感川崎病的临床探讨[J].检验医学与临床,2016,13(6):826-828.
[16]刘向阳,曹慧芳,古小东.盐酸奥洛他定片治疗过敏性鼻炎的效果及对患者血清免疫球蛋白水平的影响[J].保健医学研究与实践,2017,14(3):64-66.
[17]李晨,施红英,何跃娥,等.谷丙、谷草转氨酶与丙种球蛋白无反应型川崎病相关性的Meta分析[J].浙江医学,2016,38(22):1787-1794.
[18] Nakagama Y,Inuzuka R,Hayashi T,et al. Fever pattern and C-reactive protein predict response to rescue therapy in Kawasaki disease[J]. Pediatrics International,2016,58(3):180-184.
[19]梁雪,金莲花,张胜,等.丙种球蛋白无反应性川崎病的临床特点及危险因素分析[J].中国实验诊断学,2017,21(4):679-681.
[20]张年春,朱建华,罗文峰,等.闭合性骨折创伤患者血浆D-二聚体和纤维蛋白原水平及与创伤程度的相关性研究[J].解放军医药杂志,2017,29(4):82-84.
[21]焦爱萍,秋艳萍,黎建丽,等.双嘧达莫联合阿司匹林、丙种球蛋白治疗川崎病的疗效及其对炎性因子的影响[J].儿科药学杂志,2016,21(9):17-20.
[22]吴自明,张正宇,罗昭旸,等.丙种球蛋白非敏感型川崎病危险因素分析[J].临床儿科杂志,2018,36(1):1-4.
[23]何志萍,吴雅娟,李翠霞,等.丙种球蛋白联合阿司匹林对川崎病合并冠状动脉损伤患者T细胞亚群的影响[J].热带医学杂志,2016,16(4):510-513.
[24] Zhu F H,Ang J Y. The Clinical Diagnosis and Management of Kawasaki Disease:a Review and Update[J].Curr Infect Dis Rep,2016,18(10):32.
[25]赵坚,黄敏,谢利剑,等.联合糖皮质激素初始治疗川崎病的临床分析[J].国际儿科学杂志,2017,44(9):624-626.