Abstract:

Objective　To investigate the influencing factors of intravenous immunoglobulin (IVIG) resistance and coronary artery damage in children with Kawasaki disease (KD). Methods　A retrospective cohort study was conducted to analyze the clinical data of 205 KD children who received treatment in Yan'an University Affiliated Hospital from May 2021 to June 2024. They were all treated with IVIG. The children were divided into a drug-resistant group and a sensitive group according to whether drug resistance occurred, and the coronary artery damage after IVIG was recorded. Independent sample t test and χ² test were used for between-group comparison, and logistic regression analysis was used to analyze the influencing factors of IVIG resistance in KD children. Results　Among the 47 children in the drug-resistant group, there were 21 boys and 26 girls, 34 cases ≥2 years old and 13 cases <2 years old. Among the 158 children in the sensitive group, there were 71 boys and 87 girls, 58 cases ≥2 years old and 100 cases <2 years old. There were statistically significant differences in the proportion of central nervous system damage, age of onset, platelet count (PLT), white blood cell count (WBC), peripheral blood neutrophil percentage (N), C-reactive protein (CRP), hemoglobin (Hb), albumin (ALB), serum ferritin (SF), and sedimentation rate between the two groups (all P<0.05). Multivariate logistic regression analysis showed that age of onset ≥2 years old, low PLT, high CRP, low Hb, low ALB, high SF, and high sedimentation rate were independent risk factors for IVIG resistance in KD children (all P<0.05). There was no statistically significant difference in the coronary artery damage between the two groups at the onset [42.55% (20/47) vs. 41.14% (65/158)] (P>0.05). However, the coronary artery damage rate in the drug-resistant group was higher than that in the sensitive group at 1 week and 3 months after treatment [36.17% (17/47) vs. 21.52% (34/158), 29.79% (14/47) vs. 15.82% (25/158)] (both P<0.05). Conclusions　Age of onset ≥2 years old, low PLT, high CRP, low Hb, low ALB, high SF, and high sedimentation rate are independent risk factors for IVIG resistance in KD children. It is necessary to perform clinical management on the above factors to reduce the risk of IVIG resistance. In addition, the rate of coronary artery damage in the drug-resistant group is higher than that in the sensitive group at 1 week and 3 months after treatment. These findings provide an important reference for clinical identification of risk factors for IVIG resistance in KD children and prevention of coronary artery damage.

Key words:

Kawasaki disease,  Intravenous immunoglobulin,  Drug resistance,  Influencing factors,  Coronary artery damage,  Children

摘要：

目的　探讨川崎病（KD）患儿静脉注射免疫球蛋白（IVIG）耐药的影响因素及冠状动脉损害情况。方法　应用回顾性队列研究方式，分析2021年5月至2024年6月在延安大学附属医院进行治疗的205例KD患儿临床资料，均给予IVIG治疗，根据患儿是否出现耐药分为耐药组及敏感组，并记录患儿IVIG后冠状动脉损害情况，采用独立样本t检验或χ²检验进行组间比较，采用logistic回归分析KD患儿IVIG耐药的影响因素。结果　耐药组47例中男21例，女26例，发病年龄≥2岁34例，<2岁（13例）；敏感组158例中男71例，女87例，发病年龄≥2岁（58例），<2岁（100例）。两组中枢神经系统损害比例、发病年龄及血小板计数（PLT）、白细胞计数（WBC）、外周血中性粒细胞百分比（N）、C反应蛋白（CRP）、血红蛋白（Hb）、白蛋白（ALB）、血清铁蛋白（SF）、血沉水平比较差异均有统计学意义（均P<0.05）。多因素logistic回归分析结果显示，发病年龄≥2岁、低PLT、高CRP、低Hb、低ALB、高SF、高血沉是KD患儿IVIG耐药的独立危险因素（均P<0.05）。两组起病时冠状动脉损害情况比较差异无统计学意义［42.55%（20/47）比41.14%（65/158）］（P>0.05），但耐药组在治疗后1周及3个月冠状动脉损害率高于敏感组［36.17%（17/47）比21.52%（34/158）、29.79%（14/47）比15.82%（25/158）］（均P<0.05）。结论　发病年龄≥2岁、低PLT、高CRP、低Hb、低ALB、高SF、高血沉是KD患儿IVIG耐药的独立危险因素，临床需针对上述因素给予管理，降低IVIG耐药风险。此外，耐药组在治疗后1周及3个月的冠状动脉损害率高于敏感组。这些发现为临床识别KD患儿IVIG耐药的高危因素及预防冠状动脉损害提供了重要参考。

关键词:

川崎病, 静脉注射免疫球蛋白, 耐药, 影响因素, 冠状动脉损害, 儿童