日本小児循環器学会雑誌 Pediatric Cardiology and Cardiac Surgery

Online ISSN: 2187-2988 Print ISSN: 0911-1794
特定非営利活動法人日本小児循環器学会 Japanese Society of Pediatric Cardiology and Cardiac Surgery
〒162-0801東京都新宿区山吹町358-5アカデミーセンター Japanese Society of Pediatric Cardiology and Cardiac Surgery Academy Center, 358-5 Yamabuki-cho, Shinju-ku, Tokyo 162-0801, Japan
Pediatric Cardiology and Cardiac Surgery 31(5): 246-253 (2015)
doi:10.9794/jspccs.31.246

原著Original

重症川崎病における持続的血液濾過透析併用緩徐血漿交換療法の有効性と安全性についてThe Efficacy and Safety of Slow Plasma Exchange Plus Continuous Hemodiafiltration for Severe Kawasaki Disease

1山梨大学医学部小児科学教室Department of Pediatrics, Faculty of Medicine, University of Yamanashi ◇ 〒409-3898 山梨県中央市下河東1110番地1110 Shimo-Kato, Chuo-shi, Yamanashi 409-3898, Japan

2山梨大学医学部附属病院新生児集中治療部Neonatal Intensive Care Unit, University of Yamanashi Hospital ◇ 〒409-3898 山梨県中央市下河東1110番地1110 Shimo-Kato, Chuo-shi, Yamanashi 409-3898, Japan

3山梨大学医学部救急集中治療医学教室Department of Emergency and Critical Care Medicine, Faculty of Medicine, University of Yamanashi ◇ 〒409-3898 山梨県中央市下河東1110番地1110 Shimo-Kato, Chuo-shi, Yamanashi 409-3898, Japan

受付日:2014年12月20日Received: December 20, 2014
受理日:2015年7月31日Accepted: July 31, 2015
発行日:2015年9月1日Published: September 1, 2015
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背景:当施設で施行した重症川崎病に対する持続的血液濾過透析併用緩徐血漿交換療法(SPE+CHDF)の有用性と安全性について報告する.

方法:当施設でIVIG不応性重症川崎病に対してSPE+CHDFを施行した12例を後方視的に検討する.

結果:SPE+CHDFを12例13コース施行した.SPE+CHDF施行前の心機能検査所見は,ANP値,BNP値,心胸郭比がすべて高値であった.SPE+CHDF施行前と比較した施行1時間後,3時間後の心拍数の変化率,収縮期血圧の変化率は共に有意差はなかった.SPE+CHDFを施行中に,強心剤の使用例や血管内カテーテル感染,人工呼吸器関連肺炎合併例はなかった.全例でSPE+CHDF開始後1~4日(中央値1日)で解熱した.SPE+CHDF施行前に冠動脈病変を認めた7例は,1年以内に全例で退縮した.

結論:重症川崎病には血漿交換療法(PE)が有効である.しかし,重症川崎病は循環動態不良例が多く含まれている.このため,重症川崎病に対して安全にPEを行うためには,SPE+CHDFが有用な方法の一つである.

Background: Intravenous immunoglobulin (IVIG) is an effective treatment for Kawasaki disease. However, severe Kawasaki disease can be refractory to IVIG. The aim of the present study was to investigate the efficacy and safety of slow plasma exchange plus continuous hemodiafiltration (SPE+CHDF) for severe Kawasaki disease.

Materials and Methods: Since September 2007, we have performed SPE+CHDF for severe Kawasaki disease in 12 cases at our facility.

Results: With respect to cardiac function before SPE+CHDF, atrial natriuretic peptide (ANP) values (222.4±172.9 pg/mL), brain natriuretic peptid (BNP) values (425.8±605 pg/mL) and cardiothoracic ratio (56.3±5.6%) were high in all patients. There were no significant changes in heart rate or systolic blood pressure at 1 h and 3 h after SPE+CHDF compared with results before therapy. There were no cases of intravascular catheter infection, ventilator-associated pneumonia cases or requirement for inotropic agents. All patients became afebrile 1–4 days (median, 1 day) after SPE+CHDF. However, we performed additional treatment in two cases due to recurrence. Seven cases with a coronary artery lesion before SPE+CHDF regressed within 1 year.

Conclusion: Plasma exchange is effective for the treatment of severe Kawasaki disease. However, many cases of severe Kawasaki disease involve hemodynamic failure. Our data suggest that SPE+CHDF can be used to safely perform plasma exchange in these cases.

Key words: Kawasaki disease; plasma exchange; plasmapheresis; hemodiafiltration; safety

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