关键词: 川崎病, IVIG不敏感, 临床特点, 治疗

Abstract: AbstractObjectiveTo investigate the prevalence,outcome,risk factors and treatment of IVIG resistant Kawasaki disease. MethodsMedical charts of 233 cases with a discharge diagnosis of Kawasaki disease from January 2005 to December 2005 were reviewed retrospectively in Children's Hospital of Chongqing Medical University.A follow-up survey was also given. ResultsThirty-one (13.3 percent) of the 233 patients failed to respond to initial treatment with IVIG.The male to female ratio of IVIG resistant Kawasaki disease was 4.17,significantly higher than IVIG responsive Kawasaki disease (1.43) (P<0.05).The age distributions of the 2 groups were not different.The patients who did not respond to IVIG had higher and more severe coronary artery lesions (CAL) compared with IVIG responder (6 of 31 (19.4 percent) versus 5 of 202(2.4 percent)).The following data were obtained and compared between resistance and responder: white blood cell,neutrophil,hemoglobulin,C-reactive protein,erythrocyte sedimentation rate,albumin,and lactate dehydrogenase(LDH).Male patients with decreased albumin may be related with resistance,but they could not be good predictors of resistance.Risk factors of coronary artery leisions with IVIG resistant Kawasaki disease were not found.Additional infusions of IVIG had effects on most IVIG resistant Kawasaki disease (14/31);steroid treatment was given to 8 patients whom additional infusion of IVIG had no effects on. ConclusionIVIG resistant Kawasaki diseases are not rare,and they have higher and more severe coronary artery lesions.The risk factors of IVIG resistance and coronary artery leisions with IVIG resistant Kawasaki disease are not sure.Additional infusion of IVIG and steroid treatment with antiplatelet and anticoagulant medications have good effects on IVIG resistant Kawasaki disease.

Key words: Treatment , IVIG resistance, Clinical features