Objective To evaluate the efficacy and safety differences of immunoglobulin (IVIG) infusion rates in the treatment of Kawasaki disease (KD) in children.
Methods KD children treated in the Department of Pediatrics of Anqing First People's Hospital were retrospectively selected as the research subjects. According to different infusion speeds of IVIG, KD children were divided into 12 h-group and 24 h-group. The main outcomes observed in this study included the duration of fever and the incidence of coronary artery lesions (CAL). The secondary observation outcomes included the proportion of IVIG non-response, total IVIG dose, proportion of third-line treatment, and laboratory examination indicators (white blood cell count, neutrophil percentage, platelet count, albumin, creatinine, aspartate aminotransferase, sodium ion, C-reactive protein, and immunoglobulin G level).
Results A total of 60 children with KD were included in the study, with 41 cases in the 12 h-group and 19 cases in the 24 h-group. There were no significant differences in the duration of fever, incidence of CAL, proportion of IVIG non-response, total IVIG dose, and proportion of third-line treatment between the two groups (P>0.05). Compared with before treatment, the white blood cell count, neutrophil percentage, and C-reactive protein significantly decreased on the second day and the seventh day in both the 12 h-group and the 24 h-group (P<0.05); while platelet count, sodium ions, and immunoglobulin G significantly increased (P<0.05). Albumin showed a downward trend and then an upward trend (P<0.05), while creatinine and aspartate aminotransferase showed no significant changes (P>0.05). In addition, there were no significant statistical differences between different time points (P>0.05). Two patients in the 12 h-group experienced adverse events, while none in the 24 h-group experienced adverse events.
Conclusion The efficacy and safety of IVIG administered over 12 h were similar to those administered over 24 h.
1.朱佳聪, 张旭. 川崎病患儿静脉注射免疫球蛋白抵抗的影响因素评估及IVIGR风险预测模型构建[J]. 中国药师, 2024, 27(3): 415-422. [Zhu JC, Zhang X. Evaluation of influencing factors of intravenous immunoglobulin resistance in children with Kawasaki disease and construction of an IVIGR risk prediction model[J]. China Pharmacist, 2024, 27(3): 415-422.] DOI: 10.12173/j.issn. 1008-049X.202401069.
2.车忠丽. 基于CiteSpace的川崎病研究文献的可视化分析[J]. 华西医学, 2022, 37(6): 909-915. [Che ZL. Visual analysis of research literature on Kawasaki disease based on CiteSpace[J]. West China Medical Journal, 2022, 37(6): 909-915.] DOI: 10.7507/1002-0179.202006027.
3.Agarwal S, Agrawal DK. Kawasaki disease: etiopathogenesis and novel treatment strategies[J]. Expert Rev Clin Immunol, 2017, 3(3): 247-258. DOI: 10. 1080/1744666X.2017.1232165.
4.Oates-Whitehead RM, Baumer JH, Haines L, et al. Intravenous immunoglobulin for the treatment of Kawasaki disease in children[J]. Cochrane Database Syst Rev, 2003, 2003(4): CD004000. DOI: 10.1002/14651858.CD004000.
5.McCrindle BW, Rowley AH, Newburger JW, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a scientific statement for health professionals from the American Heart Association[J]. Circulation, 2017, 135(17): e927-e999. DOI: 10.1161/CIR.0000000000000484.
6.中华医学会儿科学分会心血管学组, 中华医学会儿科学分会风湿学组, 中华医学会儿科学分会免疫学组, 等. 川崎病诊断和急性期治疗专家共识[J]. 中华儿科杂志, 2022, 60(1): 6-13. DOI: 10.3760/cma.j.cn112140-20211018-00879.
7.Fukui S, Seki M, Minami T, et al. Efficacy and safety associated with the infusion speed of intravenous immunoglobulin for the treatment of Kawasaki disease: a randomized controlled trial[J]. Pediatr Rheumatol Online J, 2021, 19(1): 107. DOI: 10.1186/s12969-021-00601-6.
8.樊志丹, 俞海国, 胡坚, 等. 中国儿童血管炎诊断与治疗系列专家共识之四——川崎病[J]. 中国实用儿科杂志, 2023, 38(7): 481-488. [Fan ZD, Yu HG, Hu J, et al. The fourth expert consensus on the diagnosis and treatment of pediatric vasculitis in China-Kawasaki disease[J]. Chinese Journal of Practical Pediatrics, 2023, 38(7): 481-488.] DOI: 10.19538/j. ek2023070601.
9.柴瑞凡, 何玉洁. 复发性流产和反复移植失败的免疫治疗[J]. 实用药物与临床, 2021, 24(11): 1041-1046. [Chai RF, He YJ. Immunotherapy for recurrent miscarriage and recurrent transplant failure[J]. Practical Drugs and Clinical Practice, 2021, 24(11): 1041-1046.] DOI: 10.14053/j.cnki.ppcr.202111018.
10.Oda T, Nagata H, Nakashima Y, et al. Clinical Utility of Highly Purified 10% Liquid Intravenous Immunoglobulin in Kawasaki Disease[J]. J Pediatr, 2019, 214: 227-230. DOI: 10.1016/j.jpeds.2019.06.018.
11.孙梦梦. 不完全性川崎病临床特征及冠状动脉病变危险因素[D]. 广西桂林: 桂林医学院, 2023. DOI: 10.27806/d.cnki.gglyx.2023.000019.
12.苏艳媛. 川崎病并发冠状动脉病变的危险因素分析[D]. 广西桂林: 桂林医学院, 2023. DOI: 10.27806/d.cnki.gglyx.2023.000017.
13.余艳萍. 丙种球蛋白无反应型川崎病的危险因素研究 [D]. 乌鲁木齐: 新疆医科大学, 2016. DOI: 10.7666/d.D834218.
14.王从军, 雷中劲. 川崎病患儿对静脉注射免疫球蛋白治疗反应的病例对照研究[J]. 实用医学杂志, 2015, 31(16): 2651-2654. [Wang CJ, Lei ZJ. Case-control study on the response of Kawasaki disease children to intravenous immunoglobulin therapy[J]. Journal of Practical Medicine, 2015, 31(16): 2651-2654.] DOI: 10.3969/j.issn. 1006-5725.2015.16.020.
15.宋美璇, 刘斌, 刘东. 川崎病患儿丙种球蛋白耐药列线图模型的构建与验证[J]. 中国现代医学杂志, 2023, 33(23): 52-60. [Song MX, Liu B, Liu D. Construction and validation of a line graph model for resistance to gamma globulin in children with Kawasaki disease[J]. Chinese Journal of Modern Medicine, 2023, 33(23): 52-60.] DOI: 10.3969/j.issn.1005-8982.2023.23.010.
16.杜忠东, 冯迎军, 焦富勇. 静脉输注免疫球蛋白在儿童川崎病中应用的专家共识[J]. 中国当代儿科杂志, 2021, 23(9): 867-876. [Du ZD, Feng YJ, Jiao FY. Expert consensus on the application of intravenous immunoglobulin in children with Kawasaki disease[J]. Chinese Journal of Contemporary Pediatrics, 2021, 23(9): 867-876.] DOI: 10.7499/j.issn.1008-8830.2107110.
17.Orbach H, Katz U, Sherer Y, et al. Intravenous immunoglobulin: adverse effects and safe administration[J]. Clin Rev Allergy Immunol, 2005, 29(3): 173-84. DOI: 10.1385/CRIAI:29:3:173.