Intravenous gamma-globulin treatment and retreatment in Kawasaki disease
Intravenous gamma-globulin treatment and retreatment in Kawasaki disease
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DOI：
10.1097/00006454-199812000-00009
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发表时间：
1998-12-01
影响因子：
3.6
通讯作者：
Glode, MP
中科院分区：
文献类型：
--
作者：
Burns, JC;Capparelli, EV;Glode, MP
目标。为了解川崎病(RD)患者静脉注射丙种球蛋白(IVIG)的发生率和转归，采用多中心的方法，对北美9个临床中心15个月期间所有KD患儿进行了回顾性调查。在首次IVIG输注后48h，50例(13.2%)患者仍有发热，其中29例(58.0%)再次接受IVIG治疗，其中4例(13.8%)在首次IVIG输注前有冠状动脉病变。在25名基线超声心动图正常的复治患者中，5名(20.0%)发展为冠状动脉异常，被称为“治疗失败”。结论：在基线超声心动图正常的323例患者中，仅有9例(2.8%)治疗失败，其中4例(1.4%)患者在静脉注射免疫球蛋白治疗后转为无热者，5例(12.2%)患者在第一疗程静脉注射免疫球蛋白治疗后持续或复发发热(P=0.002)。接受IVIG和阿司匹林治疗的KD患者中新的冠状动脉异常的总体患病率仍然很低。静脉注射免疫球蛋白第一疗程后持续或复发的发热与治疗失败的风险增加有关(P=0.002)，静脉注射免疫球蛋白第一疗程后仍发烧的患者再次接受静脉注射免疫球蛋白治疗现在很常见(58.0%)，尽管这种做法的有效性需要通过随机试验进行评估。
Objective. To determine the prevalence and outcome of intravenous gamma-globulin (IVIG) retreatment in patients with Kawasaki disease (RD),Method, Multicenter, retrospective survey of all children with KD evaluated at nine clinical centers across North America during a 15-month period.Results, Data were available for 378 patients. At 48 h after completion of the initial IVIG infusion, 50 patients (13.2%) remained febrile, 29 (58.0%) of whom were retreated with IVIG, including 4 (13.8%) with coronary artery abnormalities before their first IVIG infusion. Among 25 retreated patients with a normal baseline echocardiogram, 5 (20.0%) developed coronary abnormalities and were termed "treatment failures." Among the 323 patients with a normal baseline echocardiogram, only 9 (2.8%) were treatment failures; treatment failure occurred in 4 of 282 (1.4%) patients who became afebrile post-IVIG and in 5 of 41 (12.2%) patients with persistent or recrudescent fever after their first course of IVIG therapy (P = 0.002),Conclusions. The overall prevalence of new coronary abnormalities in KD patients treated with IVIG and aspirin remains low. Persistent or recrudescent fever after the first course of IVIG was associated with an increased risk of treatment failure (P = 0.002), IVIG retreatment in patients who remain febrile after the first course of IVIG is now common (58.0%), although the efficacy of this practice requires assessment with a randomized trial.