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

摘要：

目的　探讨英夫利西单抗（IFX）联合他克莫司治疗免疫球蛋白初治无效川崎病患儿的效果及对免疫功能的影响。方法　选取2020年3月至2024年3月渭南市第一医院儿科收治的80例免疫球蛋白初治无效川崎病患儿，根据治疗方法分为IFX组（38例）和联合组（42例）。IFX组男22例，女16例，年龄（4.27±0.82）岁，体重（14.38±1.76）kg，热程（5.57±2.24）d。联合组男27例，女15例，年龄（4.35±0.89）岁，体重（14.43±1.64）kg，热程（5.49±2.31）d。IFX组给予IFX治疗，联合组给予IFX联合他克莫司治疗。比较两组临床症状缓解时间、冠状动脉损伤情况、免疫功能、实验室指标及不良反应。采用χ²检验、独立样本t检验、配对t检验进行统计学分析。结果　联合组的结膜充血［（2.57±0.27）d］、发热［（2.17±0.22）d］、颈淋巴结肿大缓解时间［（3.12±0.41）d］均短于IFX组［（3.76±0.43）d、（3.21±0.34）d、（4.43±0.56）d］（均P<0.05）。治疗2个月后，联合组与IFX组的冠状动脉损伤总发生率比较［21.4%（9/42）比18.4%（7/38）］，差异无统计学意义（P>0.05）。治疗1周后，联合组免疫球蛋白A（IgA）［（2.63±0.26）g/L］、IgG［（12.33±1.20）g/L］、CD4⁺水平［（39.22±4.07）%］高于IFX组［（1.80±0.17）g/L、（9.60±1.10）g/L、（35.41±3.70）%］，CD8⁺［（22.33±2.46）%］低于IFX组［（26.41±2.77）%］（均P<0.05）；联合组与IFX组的白蛋白（ALB）、直接胆红素（DBIL）、总胆红素（TBIL）水平均低于治疗前（均P<0.05），但两组ALB、DBIL、TBIL水平比较，差异均无统计学意义（均P>0.05）。联合组与IFX组的不良反应发生率比较［16.7%（7/42）比13.2%（5/38）］，差异无统计学意义（P>0.05）。结论　IFX联合他克莫司对免疫球蛋白初治无效川崎病患儿的效果及对免疫功能的影响较为显著。

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