大津赤十字病院小児科Department of Pediatrics, Otsu Red Cross Hospital ◇ Shiga, Japan
背景：川崎病に対する免疫グロブリン大量療法（IVIG）は標準治療として確立している．今回，従来の5％製剤から10％製剤に切り替えが行われた．
目的：免疫グロブリン5％製剤と10％製剤の川崎病に対する治療効果・安全性についての比較検討，および10％製剤によるIVIG不応症例に対する追加投与時間短縮の可能性についての検討．
方法：2015年1月から2019年5月までに当院で川崎病と診断しIVIGを行った5％製剤103例，10％製剤60例を対象として，後方視的に比較検討を行った．
結果：両群間で投与前の患者背景に有意差はなかった．初回IVIG不応例は，5％製剤で31例（30％），10％製剤で20例（33％）で有意差を認めなかった（p＝0.727）．初回IVIG投与から追加IVIG投与までの時間は，10％製剤で有意に短かった（48.8 vs 45.3時間，p＝0.004）．冠動脈病変（CAL）は5％製剤で1例（1.0％）認めたのみであった．重大な副作用については，両製剤とも認めなかった．
結論：免疫グロブリン10％製剤は，従来の5％製剤と同等の治療効果および安全性があり，不応例に対する追加治療を早期に実施できる可能性があると考えられた．
Background: Intravenous immunoglobulin (IVIG) is the mainstay of initial treatment for Kawasaki disease (KD). Previously, 5％ immunoglobulin was used for the treatment of patients with KD; however, a 10％ immunoglobulin preparation has recently become available.
Purpose: To analyze the safety and effectiveness of treatment with 10％ immunoglobulin in patients with KD. Additionally, we sought to determine whether it was possible to shorten the interval between the initial IVIG dose and the second IVIG dose, among the patients who did not respond to the initial IVIG dose (non-responders) in the 10％ IVIG group.
Methods: We retrospectively compared the clinical findings of 103 patients who were administered 5％ IVIG, and 60 patients who were administered 10％ IVIG between January 2015 and May 2019.
Results: The clinical profiles were not significantly different between the 5％ and 10％ groups. A total of 31 (30％) patients in the 5％ group, and 20 (33％) patients in the 10％ group, were nonresponsive to the initial IVIG dose, although these differences were not significant (p＝0.727). The interval between the initial IVIG dose and the second IVIG dose among the non-responders was significantly shorter in the 10％ IVIG group than the 5％ IVIG group (48.8 vs 45.4 hours, p＝0.004). Only one patient in the 5％ group developed coronary artery lesions, and no serious adverse events were observed.
Conclusion: Results showed that 10％ immunoglobulin is as safe and effective as 5％ immunoglobulin for the treatment of patients with KD, and can provide additional early treatment for non-responders to the initial IVIG dose.
Key words: Kawasaki disease; intravenous immunoglobulin; 10％ immunoglobulin; administration time; non-responeders
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This page was last modified on 2020-10-19T11:44:51.000+09:00
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