RESUMEN
Objective To explore the early laboratory indicators for risk of intravenous immunoglobin-resistant Kawasaki diseases. Methods The clinical data were retrospectively analyzed in 881 Kawasaki disease patients (group A: 26 cases of intravenous immunoglobin-resistant; group B: 855 cases of intravenous immunoglobin-sensitive) from July 1, 2015 to June 30, 2016. After 1:3 matching with age and sex, the regression model for each of variables including sex, age, fever days, temperature, red blood cell count (RBC), white blood cell count (WBC), neutrophil (N), lymphocyte (L), platelet count (PLT) and C reactive protein (CRP), was constructed by conditional logistic regression analysis. Results Compared with group B, group A had significantly lower RBC count and higher PLT (P<0.05). Logistic regression analysis showed that, with the age, the regression model was Y=-2.87+0.01×PLT (PLT OR=1.01, 95％ CI: 1.00～1.01, P<0.01); with the sex, Y=-32.98+0.44×WBC+0.28× N+0.01×PLT (WBC OR=1.55, 95％ CI: 1.17～2.05, P<0.01; N％ OR=1.32, 95％ CI: 1.04～1.68, P<0.05; PLT OR=1.01, 95％ CI 1.00～1.01, P<0.01). Conclusion In case that abnormally high levels of PLT exist in confirmed Kawasaki disease, it should be aware of possibility of the intravenous immunoglobin-resistant Kawasaki disease.
RESUMEN
Kawasaki disease(KD) is an acute,self-limited vasculitis of childhood and has become the leading cause of acquired pediatric heart disease.The underlying etiology remains unknown.The disease itself may be the characteristic manifestation of a common pathway of immune-mediated vascular inflammation in susceptible hosts.Intravenous immunoglobulin (IVIG) is now widely accepted as the first-line therapy for KD.However,approximately 10％-20％ of patients are resistant to IVIG.Although,an additional administration of IVIG is often chosen for the treatment of KD patients resistant to the first administration of IVIG,its efficacy is reported to be lower than that of the first IVIG dose.Thus,it is clear that some KD patients can not be treated successfully by IVIG alone,even if it is used repetitively.Currently,methylprednisolone(MP) is used for the treatment of IVIG-resistant KD.However,the proper use of MP for maximum effect and safety has not yet been elucidated.Tumor necrosis factor-α blocker,infliximab effective in the control of inflammation in patients with resistant KD.Cyclosporin treatment is also a promising option for patients with refractory KD.Plasma exchange was a safe,effective prophylactic measure against coronary artery lesions in children with KD refractory to intravenous gamma globulin therapy.