Appropriate timing of intravenous immunoglobulin in standard initial treatment for Kawasaki disease in children
Objective:To explore the appropriate time of intravenous immunoglobulin(IVIG)in standard initial treatment of Kawasaki disease in children.Methods:To consult the data of children with Kawasaki disease admitted to Department of Pediatrics,Sanming First Hospital Affiliated to Fujian Medical University from January 2016 to March 2021.A total of 163 eligible cases were re-trieved during the study period,of which 53 cases in early group were treated with initial IVIG 1～4 days after onset;initial IVIG treat-ment time was 5～7 days after onset in medium-term group,with a total of 54 cases;initial IVIG treatment time was 8～10 days after on-set in late group,with a total of 56 cases.Immune function,biological markers,echocardiography,initial IVIG non-response,hospi-talization days and main clinical manifestations after treatment were compared.Results:After treatment,levels of lymphocyte subsets in three groups were improved,among which the levels of CD4+T,CD4+T/CD8+T and CD19+T were decreased,while levels of CD3+T,CD8+T and NK were increased.Levels of biological markers were lower than those before treatment;there were significant differences in levels of lymphocyte subsets,biological markers,incidence of IVIG inactive Kawasaki disease,incidence of coronary artery lesion and coronary aneurysm among the three groups after treatment(P<0.05).The differences between the early group and the medium-term group and the late group were statistically significant(P<0.05).There was no significant difference between the medium-term group and the late group(P>0.05);and the early group had the best major clinical manifestations and the shortest hospital stay.Conclu-sion:In standard initial treatment of Kawasaki disease in children,the use of IVIG within 5 days after onset of immune function recov-ery is the best,reduce level of inflammation and protein markers is the best,but also can quickly improve clinical symptoms,shorten the length of hospital stay,and has the lowest incidence of IVIG no-response to Kawasaki disease,minimal coronary artery disease and coronary aneurysm complications,may be suitable for use.
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