川崎病静脉注射免疫球蛋白抵抗评分系统研究进展

doi:10.3877/cma.j.issn.1673-5250.2017.01.018

中华妇幼临床医学杂志(电子版) ›› 2017, Vol. 13 ›› Issue (01) : 99 -104. doi: 10.3877/cma.j.issn.1673-5250.2017.01.018

所属专题：专题评论；文献；

综述

川崎病静脉注射免疫球蛋白抵抗评分系统研究进展

吴美¹, 王川², 华益民², 周开宇²^,^†(

)

^1. 610041　成都，四川大学华西第二医院儿童心血管科，出生缺陷与相关妇儿疾病教育部重点实验室；610041　成都，四川大学华西临床医学院
^2. 610041　成都，四川大学华西第二医院儿童心血管科，出生缺陷与相关妇儿疾病教育部重点实验室

收稿日期:2016-11-10 修回日期:2017-01-05 出版日期:2017-02-01
通信作者: 周开宇

Research progress of resistance score systems of intravenous immunoglobulin in children with Kawasaki disease

Mei Wu¹, Chuan Wang², Yimin Hua², Kaiyu Zhou²^,^†()

^1. Department of Pediatric Cardiovascular, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China; West China School of Medicine, Sichuan University, Chengdu 610041, Sichuan Province, China
^2. Department of Pediatric Cardiovascular, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China

Received:2016-11-10 Revised:2017-01-05 Published:2017-02-01
Corresponding author: Kaiyu Zhou
About author:
Corresponding author: Zhou Kaiyu, Email: kaiyuzhou313@163.com

全文 ( ) 下载PDF ( ) 导出引用

引用本文：

吴美, 王川, 华益民, 周开宇. 川崎病静脉注射免疫球蛋白抵抗评分系统研究进展[J/OL]. 中华妇幼临床医学杂志(电子版), 2017, 13(01): 99-104.

Mei Wu, Chuan Wang, Yimin Hua, Kaiyu Zhou. Research progress of resistance score systems of intravenous immunoglobulin in children with Kawasaki disease[J/OL]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2017, 13(01): 99-104.

自使用大剂量静脉注射免疫球蛋白(IVIG)治疗川崎病以来，川崎病患儿冠状动脉损伤发生率显著下降。但是,10%～20%患儿对首次IVIG治疗发生抵抗，并且这些患儿较IVIG治疗敏感患儿具有更显著冠状动脉损伤趋势。目前已有部分研究对川崎病IVIG抵抗进行系统评分，旨在早期预估川崎病患儿IVIG抵抗，并指导临床治疗。笔者拟就IVIG抵抗评分系统研究进展进行综述。

关键词: 黏膜皮肤淋巴结综合征, 免疫球蛋白类,静脉内, 抵抗评分系统, 儿童

The incidence of coronary artery lesions has decreased since high-dose intravenous immunoglobulin(IVIG) was applied in children with Kawasaki disease. However, almost 10%-20% children with Kawasaki disease has the clinical features of resistance to first dose of IVIG therapy, and they were more likely of suffering from coronary artery lesions than the IVIG responders. There were several resistance score systems to evaluate IVIG resistance in Kawasaki disease, so as to predict and evaluate the response of IVIG therapy in early stage and guide clinical treatment timely. We summarized the literatures and research progress of IVIG resistance score systems in this review.

Key words: Mucocutaneous lymph node syndrome, Immunoglobulins, intravenous, Resistance score system, Child

表1 各地区川崎病静脉注射免疫球蛋白抵抗高危评分系统

文献作者	地区	总样本量(例数)	抵抗组/敏感组(例数/例数)	评分项目	得分(分)	高危与低危分界点
Egami等^[3]	日本东京	320	41/279	年龄<6个月	1	≥3分为IVIG抵抗高危，ROC曲线敏感度为78.0%，特异度为76.0%
?	?	?	?	首次IVIG治疗前发热时间<4 d	1
?	?	?	?	血小板计数<300×10⁹/L	1
?	?	?	?	CRP水平>80 mg/L	1
?	?	?	?	ALT水平>80 IU/L	2
Kobayashi　等^[4]	日本群马	676	148/528	年龄≤12个月	1	≥4分为IVIG抵抗高危，ROC曲线敏感度为86.0%，特异度为68.0%
?	?	?	?	首次IVIG治疗前发热时间≤4 d	2
?	?	?	?	血小板计数≤300×10⁹/L	1
?	?	?	?	CRP水平≥100 mg/L	1
?	?	?	?	N%≥80%	2
?	?	?	?	AST水平≥100 IU/L	2
?	?	?	?	Na^＋浓度≤133 mmol/L	2
Sano等^[5]	日本大阪	112	22/90	CRP水平≥70 mg/L	－	包含至少2条为IVIG抵抗高危，ROC曲线敏感度为77.0%，特异度为86.0%
?	?	?	?	AST水平≥200 IU/L	－
?	?	?	?	TB水平≥9 mg/L	－
Moon等^[6]	韩国首尔	91	23/68	首次IVIG治疗前发热时间<5 d	2	≥4分为IVIG抵抗高危，敏感度为74.0%，特异度为71.0%
?	?	?	?	CRP水平≥100 mg/L	1
?	?	?	?	N%≥65%	1
?	?	?	?	AST水平≥100 IU/L	1
?	?	?	?	ALT水平≥200 IU/L	1
?	?	?	?	Na^＋浓度≤136 mmol/L	2
Fu等^[7]	中国北京	1 099	200/899	皮疹	1	≥4分为IVIG抵抗高危，ROC曲线敏感度为54.1%，特异度为71.2%
?	?	?	?	肛周改变	1
?	?	?	?	首次IVIG治疗前发热时间≤4 d	2
?	?	?	?	CRP水平≥80 mg/L	2
?	?	?	?	N%≥80%	2
王丽平^[8]	中国上海	624	77/547	血小板计数≤322.50×10⁹/L	0.7	≥1.5分为IVIG抵抗高危，ROC曲线敏感度为83.1%，特异度为57.0%
?	?	?	?	血细胞比容≤29.65%	0.9
?	?	?	?	白蛋白水平≤33.35 g/L	0.8
?	?	?	?	TB水平≥7.75 μmol/L	1.3
Sato等^[9]	日本东京	105	84/21	N%≥75%	2	≥3分为IVIG抵抗高危，ROC曲线敏感度为85.7%，特异度为77.4%
?	?	?	?	IL-6水平≥140 ng/L	2
?	?	?	?	IL-6水平为70～140 ng/L	1
Tremoulet　等^[10]	美国加尼福利亚	362	60/302	首次IVIG治疗前发热时间≤4 d	1	≥3分为IVIG抵抗高危，ROC曲线敏感度为73.3%，特异度为61.9%
?	?	?	?	zHgb水平≤－2.0	1
?	?	?	?	杆状核细胞比例≥20%	2
?	?	?	?	GGT水平≥60 IU/L	1
Lin等^[11]	中国台湾	248	29/219	淋巴结肿大阳性	1	≥3分为IVIG抵抗高危，ROC曲线敏感度为86.2%，特异度为81.3%
?	?	?	?	N%≥60%	2
?	?	?	?	白蛋白水平≤35 g/L	1
Tang等^[12]	中国苏州	910	46/864	年龄<6个月	2	≥4分为IVIG抵抗高危，ROC曲线敏感度为71.4%，特异度为76.0%
?	?	?	?	皮疹	1
?	?	?	?	四肢硬肿	1
?	?	?	?	N%≥80%	1
?	?	?	?	白蛋白水平<35 g/L	2

表1 各地区川崎病静脉注射免疫球蛋白抵抗高危评分系统

文献作者	地区	总样本量(例数)	抵抗组/敏感组(例数/例数)	评分项目	得分(分)	高危与低危分界点
Egami等^[3]	日本东京	320	41/279	年龄<6个月	1	≥3分为IVIG抵抗高危，ROC曲线敏感度为78.0%，特异度为76.0%
?	?	?	?	首次IVIG治疗前发热时间<4 d	1
?	?	?	?	血小板计数<300×10⁹/L	1
?	?	?	?	CRP水平>80 mg/L	1
?	?	?	?	ALT水平>80 IU/L	2
Kobayashi　等^[4]	日本群马	676	148/528	年龄≤12个月	1	≥4分为IVIG抵抗高危，ROC曲线敏感度为86.0%，特异度为68.0%
?	?	?	?	首次IVIG治疗前发热时间≤4 d	2
?	?	?	?	血小板计数≤300×10⁹/L	1
?	?	?	?	CRP水平≥100 mg/L	1
?	?	?	?	N%≥80%	2
?	?	?	?	AST水平≥100 IU/L	2
?	?	?	?	Na^＋浓度≤133 mmol/L	2
Sano等^[5]	日本大阪	112	22/90	CRP水平≥70 mg/L	－	包含至少2条为IVIG抵抗高危，ROC曲线敏感度为77.0%，特异度为86.0%
?	?	?	?	AST水平≥200 IU/L	－
?	?	?	?	TB水平≥9 mg/L	－
Moon等^[6]	韩国首尔	91	23/68	首次IVIG治疗前发热时间<5 d	2	≥4分为IVIG抵抗高危，敏感度为74.0%，特异度为71.0%
?	?	?	?	CRP水平≥100 mg/L	1
?	?	?	?	N%≥65%	1
?	?	?	?	AST水平≥100 IU/L	1
?	?	?	?	ALT水平≥200 IU/L	1
?	?	?	?	Na^＋浓度≤136 mmol/L	2
Fu等^[7]	中国北京	1 099	200/899	皮疹	1	≥4分为IVIG抵抗高危，ROC曲线敏感度为54.1%，特异度为71.2%
?	?	?	?	肛周改变	1
?	?	?	?	首次IVIG治疗前发热时间≤4 d	2
?	?	?	?	CRP水平≥80 mg/L	2
?	?	?	?	N%≥80%	2
王丽平^[8]	中国上海	624	77/547	血小板计数≤322.50×10⁹/L	0.7	≥1.5分为IVIG抵抗高危，ROC曲线敏感度为83.1%，特异度为57.0%
?	?	?	?	血细胞比容≤29.65%	0.9
?	?	?	?	白蛋白水平≤33.35 g/L	0.8
?	?	?	?	TB水平≥7.75 μmol/L	1.3
Sato等^[9]	日本东京	105	84/21	N%≥75%	2	≥3分为IVIG抵抗高危，ROC曲线敏感度为85.7%，特异度为77.4%
?	?	?	?	IL-6水平≥140 ng/L	2
?	?	?	?	IL-6水平为70～140 ng/L	1
Tremoulet　等^[10]	美国加尼福利亚	362	60/302	首次IVIG治疗前发热时间≤4 d	1	≥3分为IVIG抵抗高危，ROC曲线敏感度为73.3%，特异度为61.9%
?	?	?	?	zHgb水平≤－2.0	1
?	?	?	?	杆状核细胞比例≥20%	2
?	?	?	?	GGT水平≥60 IU/L	1
Lin等^[11]	中国台湾	248	29/219	淋巴结肿大阳性	1	≥3分为IVIG抵抗高危，ROC曲线敏感度为86.2%，特异度为81.3%
?	?	?	?	N%≥60%	2
?	?	?	?	白蛋白水平≤35 g/L	1
Tang等^[12]	中国苏州	910	46/864	年龄<6个月	2	≥4分为IVIG抵抗高危，ROC曲线敏感度为71.4%，特异度为76.0%
?	?	?	?	皮疹	1
?	?	?	?	四肢硬肿	1
?	?	?	?	N%≥80%	1
?	?	?	?	白蛋白水平<35 g/L	2

[1]	Newburger JW, Takahashi M, Gerber MA, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association[J]. Pediatrics，2004，114(6)：1708-1733.
[2]	Galeotti C, Kaveri SV, Cimaz R, et al. Predisposing factors, pathogenesis and therapeutic intervention of Kawasaki disease[J]. Drug Discov Today, 2016, 21(11): 1850-1857.
[3]	Egami K, Muta H, Ishii M, et al. Prediction of resistance to intravenous immunoglobulin treatment in patients with Kawasaki disease[J]. J Pediatr, 2006, 149(2): 237-240.
[4]	Kobayashi T, Inoue Y, Takeuchi K, et al. Prediction of intravenous immunoglobulin unresponsiveness in patients with Kawasaki disease[J]. Circulation, 2006, 113(22): 2606-2612.
[5]	Sano T, Kurotobi S, Matsuzaki K, et al. Prediction of non-responsiveness to standard high-dose gamma-globulin therapy in patients with acute Kawasaki disease before starting initial treatment[J]. Eur J Pediatr, 2007, 166(2): 131-137.
[6]	Moon KP, Kim BJ, Lee KJ, et al. Prediction of nonresponsiveness to medium-dose intravenous immuno-globulin (1 g/kg) treatment: an effective and safe schedule of acute treatment for Kawasaki disease[J]. Korean J Pediatr, 2016, 59(4): 178-182.
[7]	Fu PP, Du ZD, Pan YS. Novel predictors of intravenous immunoglobulin resistance in Chinese children with Kawasaki disease[J]. Pediatr Infect Dis J, 2013, 32(8): e319-e323.
[8]	王丽平. 免疫球蛋白无反应型川崎病危险因素的研究及评分体系探讨[D]．上海：上海交通大学,2014.
[9]	Sato S, Kawashima H, Kashiwagi Y, et al. Inflammatory cytokines as predictors of resistance to intravenous immunoglobulin therapy in Kawasaki disease patients[J]. Int J Rheum Dis, 2013, 16(2): 168-172.
[10]	Tremoulet AH, Best BM, Song S, et al. Resistance to intravenous immunoglobulin in children with Kawasaki disease[J]. J Pediatr, 2008, 153(1): 117-121.
[11]	Lin MT, Chang CH, Sun LC, et al. Risk factors and derived formosa score for intravenous immunoglobulin unrespon-siveness in Taiwanese children with Kawasaki disease[J]. Taiwan Yi Zhi, 2016, 115(5): 350-355.
[12]	Tang Y, Yan W, Sun L, et al. Prediction of intravenous immunoglobulin resistance in Kawasaki disease in an East China population[J]. Clin Rheumatol, 2016, 35(11): 2771-2776.
[13]	Research Committee of the Japanese Society of Pediatric Cardiology; Cardiac Surgery Committee for Development of Guidelines for Medical Treatment of Acute Kawasaki Disease. Guidelines for medical treatment of acute Kawasaki disease: report of the Research Committee of the Japanese Society of Pediatric Cardiology and Cardiac Surgery (2012 revised version)[J]. Pediatr Int, 2014, 56(2): 135-158.
[14]	Uehara R, Belay ED, Maddox RA, et al. Analysis of potential risk factors associated with nonresponse to initial intravenous immunoglobulin treatment among Kawasaki disease patients in Japan[J]. Pediatr Infect Dis J, 2008, 27(2): 155-160.
[15]	Kim HK, Oh J, Hong YM, et al. Parameters to guide retreatment after initial intravenous immunoglobulin therapy in Kawasaki disease[J]. Korean Circ J, 2011, 41(7)：379-384.
[16]	Kim BY, Kim D, Kim YH, et al. Non-responders to intravenous immunoglobulin and coronary artery dilatation in Kawasaki disease: predictive parameters in Korean children[J]. Korean Circ J, 2016, 46(4): 542-549.
[17]	Wei M, Huang M, Chen S, et al. A multicenter study of intravenous immunoglobulin non-response in Kawasaki disease[J]. Pediatr Cardiol, 2015, 36(6): 1166-1172.
[18]	Hartas GA, Hashmi SS, Pham-Peyton C, et al. Immunoglobulin resistance in Kawasaki disease[J]. Pediatr Allergy Immunol Pulmonol, 2015, 28(1): 13-19.
[19]	Kuo HC, Liang CD, Wang CL, et al. Serum albumin level predicts initial intravenous immunoglobulin treatment failure in Kawasaki disease[J]. Acta Paediatr, 2010, 99(10): 1578-1583.
[20]	Park HM, Lee DW, Hyun MC, et al. Predictors of nonresponse to intravenous immunoglobulin therapy in Kawasaki disease[J]. Korean J Pediatr, 2013, 56(2): 75-79.
[21]	Davies S, Sutton N, Blackstock S, et al. Predicting IVIG resistance in UK Kawasaki disease[J]. Arch Dis Child, 2015, 100(4): 366-368.
[22]	Sánchez-Manubens J, Antón J, Bou R, et al. Role of the Egami score to predict immunoglobulin resistance in Kawasaki disease among a Western Mediterranean population[J]. Rheumatol Int, 2016, 36(7): 905-910.
[23]	Ogata S, Shimizu C, Franco A, et al. Treatment response in Kawasaki disease is associated with sialylation levels of endogenous but not therapeutic intravenous immunoglobulin G[J]. PLoS One, 2013, 8(12): e81448.
[24]	Xing Y, Wang H, Liu X, et al. Exploring the genes associated with the response to intravenous immunoglobulin in patients with Kawasaki disease using DNA microarray analysis[J]. Exp Mol Pathol, 2015, 98(1): 7-12.
[25]	Cha S, Yoon M, Ahn Y, et al. Risk factors for failure of initial intravenous immunoglobulin treatment in Kawasaki disease[J]. J Korean Med Sci, 2008, 23(4): 718-722.
[26]	Durongpisitkul K, Soongswang J, Laohaprasitiporn D, et al. Immunoglobulin failure and retreatment in Kawasaki disease[J]. Pediatr Cardiol, 2003, 24(2): 145-148.
[27]	Lee SM, Lee JB, Go YB, et al. Prediction of resistance to standard intravenous immunoglobulin therapy in Kawasaki disease[J]. Korean Circ J, 2014, 44(6): 415-422.
[28]	Fukunishi M, Kikkawa M, Hamana K, et al. Prediction of non-responsiveness to intravenous high-dose gamma-globulin therapy in patients with Kawasaki disease at onset[J]. J Pediatr, 2000, 137(2): 172-176.
[29]	Kuo HC, Yang KD, Liang CD, et al. The relationship of eosinophilia to intravenous immunoglobulin treatment failure in Kawasaki disease[J]. Pediatr Allergy Immunol, 2007, 18(4): 354-359.
[30]	Ha KS, Lee J, Jang GY, et al. Value of neutrophil-lymphocyte ratio in predicting outcomes in Kawasaki disease[J]. Am J Cardiol, 2015, 116(2): 301-306.
[31]	Kawamura Y, Takeshita S, Kanai T, et al. The combined usefulness of the neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios in predicting intravenous immunoglobulin resistance with Kawasaki disease[J]. J Pediatr, 2016, 178: 281-284.e1.
[32]	Dominguez SR, Martin B, Heizer H, et al. Procalcitonin (PCT) and Kawasaki disease: does PCT correlate with IVIG-resistant disease, admission to the intensive care unit, or development of coronary artery lesions？[J]. J Pediatric Infect Dis Soc, 2016, 5(3): 297-302.
[33]	Koyanagi H, Nakamura Y, Yanagawa H. Lower level of serum potassium and higher level of C-reactive protein as an independent risk factor for giant aneurysms in Kawasaki disease[J]. Acta Paediatr, 1998, 87(1): 32-36.
[34]	Yanagimoto K, Nomura Y, Masuda K, et al. Immunoglobulin G values before treatment are correlated with the responsiveness to initial intravenous immunoglobulin therapy for Kawasaki disease[J]. Int Arch Allergy Immunol, 2014, 164(2): 83-88.
[35]	Ye Q, Gong FQ, Shang SQ, et al. Intravenous immunoglobulin treatment responsiveness depends on the degree of CD₈⁺ cell activation in Kawasaki disease[J]. Clin Immunol, 2016, 171: 25-31.
[36]	Wakiguchi H, Hasegawa S, Suzuki Y, et al. Relationship between T-cell HLA-DR expression and intravenous immunoglobulin treatment response in Kawasaki disease[J]. Pediatr Res, 2015, 77(4): 536-540.
[37]	Kuo HC, Chang JC, Kuo HC, et al. Identification of an association between genomic hypomethylation of FCGR2A and susceptibility to Kawasaki disease and intravenous immunoglobulin resistance by DNA methylation array[J]. Arthritis Rheumatol, 2015, 67(3): 828-836.
[38]	Weng KP, Hsieh KS, Ho TY, et al. IL-1B polymorphism in association with initial intravenous immunoglobulin treatment failure in Taiwanese children with Kawasaki disease[J]. Circ J, 2010, 74(3): 544-551.
[39]	Fury W, Tremoulet AH, Watson VE, et al. Transcript abundance patterns in Kawasaki disease patients with intravenous immunoglobulin resistance[J]. Hum Immunol, 2010, 71(9): 865-873.
[40]	Minami T, Suzuki H, Takeuchi T, et al. A polymorphism in plasma platelet-activating factor acetylhydrolase is involved in resistance to immunoglobulin treatment in Kawasaki disease[J]. J Pediatr, 2005, 147(1): 78-83.
[41]	Shendre A, Wiener HW, Zhi D, et al. High-density genotyping of immune loci in Kawasaki disease and IVIG treatment response in European-American case-parent trio study[J]. Genes Immun, 2014, 15(8): 534-542.
[42]	Kim GB, Han JW, Park YW, et al. Epidemiologic features of Kawasaki disease in South Korea: data from nationwide survey, 2009-2011[J]. Pediatr Infect Dis J, 2014, 33(1): 24-27.
[43]	Moffett BS, Syblik D, Denfield S, et al. Epidemiology of immunoglobulin resistant Kawasaki disease: results from a large, national database[J]. Pediatr Cardiol, 2015, 36(2): 374-378.
[44]	Kanamitsu K, Kakimoto H, Shimada A, et al. Verification of risk scores to predict i．v. immunoglobulin resistance in incomplete Kawasaki disease[J]. Pediatr Int, 2016, 58(2): 146-151.
[45]	Cho KH, Kang SJ. Clinically useful predictors of resistance to intravenous immunoglobulin and prognosis of coronary artery lesions in patients with incomplete Kawasaki disease[J]. Korean Circ J, 2014, 44(5)：328-335.

[1]	陶宏宇, 叶菁菁, 俞劲, 杨秀珍, 钱晶晶, 徐彬, 徐玮泽, 舒强. 右心声学造影在儿童右向左分流相关疾病中的评估价值[J/OL]. 中华医学超声杂志（电子版）, 2024, 21(10): 959-965.
[2]	刘琴, 刘瀚旻, 谢亮. 基质金属蛋白酶在儿童哮喘发生机制中作用的研究现状[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(05): 564-568.
[3]	向韵, 卢游, 杨凡. 全氟及多氟烷基化合物暴露与儿童肥胖症相关性研究现状[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(05): 569-574.
[4]	刘静, 王燕妮, 王继萍. 儿童毛发移植应用前景及病例讨论[J/OL]. 中华损伤与修复杂志(电子版), 2024, 19(04): 368-368.
[5]	郑宝英, 黄小兰, 贾楠, 朱春梅. 儿童难治性肺炎支原体肺炎早期预警指标[J/OL]. 中华实验和临床感染病杂志(电子版), 2024, 18(04): 215-221.
[6]	刘冉佳, 崔向丽, 周效竹, 曲伟, 朱志军. 儿童肝移植受者健康相关生存质量评价的荟萃分析[J/OL]. 中华移植杂志(电子版), 2024, 18(05): 302-309.
[7]	丁荷蓓, 王珣, 陈为国. 七氟烷吸入麻醉与异丙酚静脉麻醉在儿童腹股沟斜疝手术中的应用比较[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(05): 570-574.
[8]	曾纪晓, 徐晓钢, 王欣星, 刘斐, 兰梦龙, 陶波圆, 梁子建, 叶志华, 罗媛圆. 达芬奇机器人辅助Swenson-like巨结肠根治术[J/OL]. 中华腔镜外科杂志(电子版), 2024, 17(04): 239-243.
[9]	中华医学会器官移植学分会, 中华医学会外科学分会外科手术学学组, 中华医学会外科学分会移植学组, 华南劈离式肝移植联盟. 劈离式供肝儿童肝移植中国临床操作指南[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(05): 593-601.
[10]	刘军, 丘文静, 孙方昊, 李松盈, 易述红, 傅斌生, 杨扬, 罗慧. 在体与离体劈离式肝移植在儿童肝移植中的应用比较[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(05): 688-693.
[11]	张佳臣, 宋红欣. 儿童青少年等效球镜屈光度变化与屈光不正进展相关性的临床研究[J/OL]. 中华眼科医学杂志(电子版), 2024, 14(04): 217-222.
[12]	张琛, 秦鸣, 董娟, 陈玉龙. 超声检查对儿童肠扭转缺血性改变的诊断价值[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(06): 565-568.
[13]	王晓瑜, 郭群英, 牛雅萌, 赵成松. 公立儿童医院促进儿科就医均等化实践探析[J/OL]. 中华临床医师杂志(电子版), 2024, 18(04): 383-387.
[14]	陈晓胜, 何佳, 刘方, 吴蕊, 杨海涛, 樊晓寒. 直立倾斜试验诱发31 秒心脏停搏的植入心脏起搏器儿童一例并文献复习[J/OL]. 中华脑血管病杂志(电子版), 2024, 18(05): 488-494.
[15]	曹亚丽, 高雨萌, 张英谦, 李博, 杜军保, 金红芳. 儿童坐位不耐受的临床进展[J/OL]. 中华脑血管病杂志(电子版), 2024, 18(05): 510-515.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

Research progress of resistance score systems of intravenous immunoglobulin in children with Kawasaki disease

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

Research progress of resistance score systems of intravenous immunoglobulin in children with Kawasaki disease