High-dose versus low-dose intravenous immunoglobulin for treatment of children with Kawasaki disease weighing 25 kg or more
High-dose versus low-dose intravenous immunoglobulin for treatment of children with Kawasaki disease weighing 25 kg or more
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DOI：
10.1007/s00431-020-03794-2
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发表时间：
2020-08-29
影响因子：
3.6
通讯作者：
Yasunaga, Hideo
中科院分区：
文献类型：
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作者：
Suzuki, Takanori;Michihata, Nobuaki;Yasunaga, Hideo
对于年龄较大的川崎患儿，2-g/kg的IVIG是否有必要，目前尚不清楚，因为他们可能有更多的并发症和经济负担。本研究的目的是使用2010年至2017年日本国家住院患者数据库，比较高体重（25 kg或以上）KD儿童高剂量和低剂量IVIG的结局。我们确定了接受2-g/kg和1-g/kg IVIG作为初始治疗的患者。结果包括冠状动脉异常（CAA）形成的比例，IVIG抵抗，不良反应，住院时间和医疗费用。进行倾向评分匹配分析以比较组间的结局。我们确定了1332例KD患者，并在高剂量和低剂量IVIG组之间建立了4：1的倾向评分匹配对。CAA的比例（5.3% vs. 4.1%;p= 0.587）、IVIG抵抗和住院时间无显著差异。高剂量组的医疗费用明显高于低剂量组（p< 0.001）。结论：IVIG高剂量组与低剂量组的结局比例差异无统计学意义，但高剂量组的医疗费用较高。需要进一步的研究来确定合适的IVIG剂量在老年KD患者。
Little is known whether 2-g/kg IVIG is necessary for older children with Kawasaki disease (KD), because they could have more complications and financial burden. The purpose of this study was to compare outcomes between high- and low-dose IVIG in KD children with higher body weight (25 kg or more), using a national inpatient database in Japan from 2010 to 2017. We identified those receiving 2-g/kg and 1-g/kg IVIG as an initial treatment. Outcomes included the proportions of coronary artery abnormality (CAA) formation, IVIG resistance, adverse effects, length of stay, and medical costs. A propensity score matching analysis was conducted to compare the outcomes between the groups. We identified 1332 patients with KD and created 4:1 propensity score-matched pairs between high- and low-dose IVIG groups. There were no significant differences in the proportions of CAA (5.3% vs. 4.1%;p= 0.587), IVIG resistance, and length of stay. Medical costs were significantly higher in the high-dose group than in the low-dose group (p< 0.001).Conclusion: No significant difference was shown between the high- and low-dose IVIG groups in the proportions of outcomes, while medical costs were higher in the high-dose group. Further studies are needed to ascertain the appropriate IVIG dose in older patients with KD.