Early Immunoglobulin Therapy and Outcomes in Kawasaki Disease: A Nationwide Cohort Study.
Early Immunoglobulin Therapy and Outcomes in Kawasaki Disease: A Nationwide Cohort Study.
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DOI：
10.1097/md.0000000000001544
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发表时间：
2015-09
期刊：
影响因子：
1.6
通讯作者：
Jan SL
中科院分区：
文献类型：
--
作者：
Ho CL;Fu YC;Lin MC;Jan SL
川崎病是大多数工业化国家儿童获得性心脏病的主要原因；然而，只有少数描述性研究讨论了早期免疫球蛋白治疗的利弊。本研究旨在观察早期免疫球蛋白治疗对川崎病预后的影响。首次接受免疫球蛋白治疗的患者被纳入研究。对基本资料进行描述性流行病学分析。入院前4 ~ 12天未开退烧药者作为早期免疫球蛋白治疗组。比较两组发生急性动脉瘤的风险、需要长期抗凝治疗的风险和复发率。在5235例首次发作的川崎病患者中，1156例接受了早期免疫球蛋白治疗。急性动脉瘤和需要长期抗凝治疗的优势比分别为0.99（95%可信区间[CI]， 0.75-1.29）和1.06 （95% CI, 0.86-1.31）。早期免疫球蛋白治疗组复发率较高，校正风险比为1.38 （95% CI, 1.29-1.47）。在这项观察性研究中，早期免疫球蛋白治疗可能对川崎病患儿的冠状动脉结局没有益处。相反，它可能与较高的复发率有关。一项比较早期和晚期静脉注射免疫球蛋白治疗的随机对照研究可能会带来相关结果。
Kawasaki disease is the leading cause of acquired heart disease among children in most industrialized countries; however, only few descriptive studies have discussed the pros and cons of early immunoglobulin therapy. This study aimed to see the effect of early immunoglobulin therapy on Kawasaki disease outcomes. Patients who received immunoglobulin therapy for the first time were enrolled. Basic data were analyzed for descriptive epidemiology. If there was no prescription of antipyretics 4 to 12 days before admission, those patients were regarded as early immunoglobulin therapy group. The risk for acute aneurysm, requiring long-term anticoagulant therapy and recurrence rate were compared. Of 5235 patients with first attack of Kawasaki disease, 1156 received early immunoglobulin therapy. The odds ratios for acute aneurysm and needing long-term anticoagulant therapy were 0.99 (95% confidence interval [CI], 0.75–1.29) and 1.06 (95% CI, 0.86–1.31), respectively. The recurrence rate was higher for the early immunoglobulin therapy group, with an adjusted hazard ratio of 1.38 (95% CI, 1.29–1.47). Early immunoglobulin therapy might not be beneficial for the coronary outcomes of children with Kawasaki disease in this observational study. On the contrary, it might be associated with higher recurrence rate. A randomized controlled study comparing early and late intravenous immunoglobulin therapy would have probably brought relevant results.