关键词:

英夫利西单抗, 他克莫司, 川崎病, 免疫球蛋白初治无效, 免疫功能, 儿童

Abstract:

Objective　To explore the effect of infliximab (IFX) combined with tacrolimus in treating children with Kawasaki disease resistant to initial immunoglobulin therapy and its impact on immune function. Methods　Eighty children with Kawasaki disease resistant to initial immunoglobulin therapy were selected from the Department of Pediatrics of Weinan First Hospital from March 2020 to March 2024, and were divided into an IFX group (38 cases) and a combination group (42 cases) according to the treatment methods. In the IFX group, there were 22 boys and 16 girls, with an age of (4.27±0.82) years old, a weight of (14.38±1.76) kg, and a duration of fever of (5.57±2.24) d. In the combination group, there were 27 boys and 15 girls, with an age of (4.35±0.89) years old, a weight of (14.43±1.64) kg, and a duration of fever of (5.49±2.31) d. The IFX group was given IFX treatment, and the combination group was given IFX combined with tacrolimus treatment. The clinical symptom relief time, coronary artery lesions, immune function, laboratory indicators, and adverse reactions were compared between the two groups. χ² test, independent sample t test, and paired t test were used for statistical analysis. Results　The relief time of conjunctival hyperemia [(2.57±0.27) d], fever [(2.17±0.22) d], and cervical lymph enlargement [(3.12±0.41) d] in the combination group were shorter than those in the IFX group [(3.76±0.43) d, (3.21±0.34) d, and (4.43±0.56) d] (all P<0.05). Two months after treatment, there was no statistically significant difference in the total incidence of coronary artery lesions between the combination group and the IFX group [21.4% (9/42) vs. 18.4% (7/38)] (P>0.05). One week after treatment, the levels of immunoglobulin A (IgA) [(2.63±0.26) g/L], IgG [(12.33±1.20) g/L], and CD4⁺ [(39.22±4.07)%] in the combination group were higher than those in the IFX group [(1.80±0.17) g/L, (9.60±1.10) g/L, and (35.41±3.70)%], but the CD8⁺ [(22.33±2.46)%] was lower than that in the IFX group [(26.41±2.77)%] (all P<0.05); the levels of albumin (ALB), direct bilirubin (DBIL), and total bilirubin (TBIL) in the combination group and the IFX group were lower than those before treatment (all P<0.05), but there was no statistically significant difference in the level of ALB, DBIL, or TBIL between the two groups (all P>0.05). There was no statistically significant difference in the incidence of adverse reactions between the combination group and the IFX group [16.7% (7/42) vs. 13.2% (5/38)] (P>0.05). Conclusion　The combination of IFX and tacrolimus significantly affects the treatment efficacy and immune function in children with Kawasaki disease resistant to initial immunoglobulin therapy.

Key words:

Infliximab,  Tacrolimus; , Kawasaki disease,  Immunoglobulin-resistant,  Immune function,  Children