Early recognition and treatment of intravenous immunoglobulin unresponsive patients with Kawasaki disease / 国际儿科学杂志

ABSTRACT

The cause of Kawasaki disease(KD) remains unclear.Coronary artery lesions (CAL)can occur in 20％ ～25％ children with untreated KD.The usage of high-dose intravenous immunoglobulin(IVIG) has reduced the incidence of CAL,but some patients will not respond to IVIG and have a higher incidence of CAL.Early recognition of IVIG unresponsiveness patients with KD may help physicians to adjust treatment and to improve the prognosis.Factors related to IVIG unresponsive including clinical characteristics and laboratory findings.Clinical scoring systems were also used to predict IVIG unresponsive KD patients.But there was a lack of a better scoring system or method that have been validated by clinicians.Retreatment with IVIG was a widely accepted therapy in IVIG unresponsive KD patients by now.Using effective agents such as corticosteroids and TNF-α antagonists in a timely way may play an important role to reduce the incidence of CAL in IVIG unresponsive KD patients.But there is no standard treatment protocol for IVIG unresponsive KD currently.This paper reviewed the progress in early recognition and treatment of IVIG unresponsive KD patients to provide reference for clinicians.