Risk Factors Of Intravenous Immunoglobulin Resistance And Coronary Artery Lesions In Kawasaki Disease

Part I Risk factors of intravenous immunoglobulin resistance in kawasaki diseaseObjective To investigate the risk factors of intravenous immunoglobulin resistance in kawasaki disease.Methods Totally446Kawasaki disease from January2009to August2010treated in our hospital were reviewed.Results:Of the446patients,66were failed to initial IVIG treatment, account for29.1%.Compared with IVIG responsive patients.the risk factors for IVIG resistant Kawasaki disease were male patients.time initially intaking IVIG(the first4days of the illness), WBC(≥20×10∧9/L),N%(≥75%),PLT(≤300×10∧9/L),ALT(≥100U/L),AST(≥100U/L),ALB(≤35g/L),Na+(≤133mmol/L),K+(≤3.3mmol/L).Among these risk factors, male patients,time initially intaking IVIG(the first4days of the illness), ALB(≤35g/L) were independently risk factors.Among those patients,36under1year old in the IVIG resistant group,with no sensible difference to the IVIG responsive group. There were not statistical differences between the two groups in levels of ESR and HB. Additional infusion of IVIG is always the first choice in patients with IVIG resistant Kawasaki disease.If it does not work.steroid treatment with antiplatelet and anticoagulant medications also showed good effects.Conclusions heavily dosed with IVIG infusing is an effective treatment.but with a high rate of29.1%IVIG resistant. Male patients.time initially intaking IVIG (the first4days of the illness). ALB(<35g/L) are the high-risk factors. KD should be treated immediately, but systematic research should be carrred out.Part Ⅱ Risk factors of coronary artery lesions(CAL) in Kawasaki disease(KD)Objective To further analyze the risk factors of coronary artery lesions(CAL) in Kawasaki disease(KD).Methods This is a retrospective.historical controlled study.Totally473patients with KD from2009.1to2010.8at the Children’s Hospital of Zhejiang University School of Medicine,were enrolled as the subjects of this study. They were divided into two groups—One with coronary artery lesions, the other without. The feature of epidemiology an clinical manifestations, laboratory results, treatments and outcomes with IVIG were summarized. Statistics were performed by using SPSS18.0software. Results:(1) KD occurred more frequently in spring and summer,but also with one peak in October;89.4%occurred among children≤5years of age;The incidence rate of CAL was22.4%,the incidence rate of CAA was22.4%.The male-to-female ratio in the CAL group was2.42:1.(2) Statistical analysis showed that gender, Leukocytosis、CRP、the percentage of monocytes、Eosinophils、serum potassium、sodium、AST、cholesterol、 triglycerides、IL-6、IL-10、TNF-α、 the time of IVIG treatment and IVIG-resistance all to be no significant difference between the two groups; After the treatment of IVIG, WBC, neutrophil percentage, monocyte percentage and CRP declined obviously,while platelet count significantly increased.(2) Univariate analysis indicated that the age(≤3years)、long lasting time of fever (>10days)、incomplete Kawasaki disease、low level of Hb (<90g/L)、Neutrophil percentage>80%、PLT<300×10∧9/L、Platelet hematocrit (PCT)、serum albumin(ALB) and with no treatment of IVIG, were closely associated with CAL. Multivariate Logistic regression identified that age(≤3years), PLT<300×10∧9/L and with no treatment of IVIG were independently risk factors correlated with CAL secondary to KD.Conclusions In order to reduce the incidence rate of CAL.IVIG should be used in time(within10days),which can shorten the heating time and reduce the neutrophil percentage; More attention should be paid to the patients in or under3years old, and those with a Laboratory result of PLT<300×l0∧9/L, especially the Dynamic monitoring of Doppler echocardiography.