Abstract:

Objective To investigate the treatment effect of steroid for intravenous immunoglobulin (IVIG) unresponsive Kawasaki disease (KD).Methods Data of children with initial IVIG unresponsive KD in Children′s Hospital of Chongqing Medical University were retrospectively collected. Total cases were divided into 3 groups: IVIG only, steroid only and IVIG plus steroid according to re-treatment methods. Those who used steroid including steroid group and IVIG plus steroid group were divided into intravenous sequentially oral steroid group(intravenous-oral steroid group) and oral steroid group. The whole fever time,duration of fever after re-treatment, laboratory examination results before and after re-treatment were focused and the difference ratio△(the ratio of the difference value before and after re-treatment to the value before re-treatment) was calculated. Coronary artery lesions (CALs) outcomes were observed in acute stage and CALs and thrombus 6,12 and 24 months after hospital discharge were followed-up.Results A total of 143 children with initial IVIG unresponsive KD were analyzed. There were 107 cases in IVIG group, 12 cases in steroid group and 24 cases in IVIG plus steroid group. There was no significant difference in gender, age and weight among three groups. Compared with IVIG group, WBC and PLT after re-treatment and △CRP were higher in IVIG plus steroid group, and the whole fever time of this group was longer. However the △WBC and △PLT were lower in IVIG plus steroid group. The incidence of coronary artery aneurysm in acute stage and coronary artery dilatation 6 months after hospital discharge was higher in IVIG plus steroid group than that of IVIG group. Compared with IVIG group, △WBC was lower and the whole fever time was longer in steroid group. There were 18 cases in intravenous-oral steroid group and oral steroid group respectively. No statistically significant difference in gender, age and weight was found between those two groups. In oral steroid group, △CRP was lower and △PLT was higher than those of intravenous-oral steroid group. There was no significant difference in long-term progression of coronary artery between the two groups. In the follow-up cases, 2 cases with thrombosis were found in the intravenous-oral steroid group, but the thrombus disappeared after anti-coagulation therapy.Conclusion This study suggested that direct application of steroid treatment is effective and relatively safe in acute stage for initial IVIG unresponsive KD patients, and the incidence of CALs does not increase in long-term follow-up. Taking ordinary dose steroid orally or intravenous-oral way showed no significant difference on the effect of the treatment in acute period and long-term prognosis for initial IVIG unresponsive KD patients. But intravenous-oral way has an increased thrombotic risk.