Immunoglobulin Resistance in Kawasaki Disease
Immunoglobulin Resistance in Kawasaki Disease
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DOI：
10.1089/ped.2014.0423
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发表时间：
2015-03-01
影响因子：
0.9
通讯作者：
Gupta-Malhotra, Monesha
中科院分区：
文献类型：
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作者：
Hartas, Georgios A.;Hashmi, Syed Shahrukh;Gupta-Malhotra, Monesha
背景资料：本研究的目的是确定免疫球蛋白抵抗的危险因素，包括临床症状，如关节炎和静脉注射immunoglobulin.Methods的pH值：儿童川崎病谁收到免疫球蛋白的数据进行了评估。有关品牌的免疫球蛋白管理的数据从药房records.Results：连续80名儿童与川崎病进行了评价（Mdn（年龄）=28个月，66%男性）。免疫球蛋白耐药率为30%。关节炎是川崎急性期的主要症状，占8%（6/80，均为男性），与无关节炎的患者相比，关节炎与免疫球蛋白抵抗显著相关（16.7% vs. 0.2%，p=0.008）。接下来，将免疫球蛋白品牌类型分为两组：相对高pH组（n=16），包括Carimune（pH 6.6 +/- 0.2），和低pH组（n=63），包括Gamunex（pH 4-4.5）或Privigen（pH 4.6-5）。总的来说，低pH和高pH组之间的免疫球蛋白反应性没有显著差异（73% vs. 56%，p=0.193），尽管低pH组显示出红细胞沉降率下降幅度更大的趋势（p=0.048），类固醇使用率较低（p=0.054），冠脉受累较低（p=0.08）高于高pH组。在川崎急性期出现关节炎的儿童可能存在免疫球蛋白抵抗的风险。
Background: The aim of this study was to identify risk factors for immunoglobulin resistance, including clinical symptoms such as arthritis and the pH of intravenous immunoglobulin.Methods: The data of children with Kawasaki disease who had received immunoglobulin were evaluated. Data regarding the brand of immunoglobulin administered were abstracted from the pharmacy records.Results: Eighty consecutive children with Kawasaki disease were evaluated (Mdn(age)=28 months, 66% male). The prevalence of immunoglobulin resistance was 30%. Arthritis was a presenting symptom in the acute phase of Kawasaki disease in 8% (6/80, all male) and was seen in significant association with immunoglobulin resistance in comparison to those without arthritis (16.7% vs. 0.2%, p=0.008). Next, the immunoglobulin brand types were divided into two groups: the relatively high pH group (n=16), including Carimune (pH 6.6 +/- 0.2), and the low pH group (n=63), including Gamunex (pH 4-4.5) or Privigen (pH 4.6-5). Overall, no significant difference in immunoglobulin responsiveness was found between the low pH and the high pH groups (73% vs. 56%, p=0.193), although the low pH group showed a trend toward a larger decrease in erythrocyte sedimentation rate (p=0.048), lower steroid use (p=0.054), and lower coronary involvement (p=0.08) than those in the high pH group.Conclusions: Children presenting with arthritis in the acute phase of Kawasaki disease may be at risk for immunoglobulin resistance.