背景 雖然川崎氏病的病因未明，但以高劑量靜脈注射脈注射免疫球蛋白能減少冠狀動脈瘤的發生。各種廠牌的免疫球蛋白成份稍有差異，是否會造成不同的結果，是常被提及的問題。方法 本研究以在本院住院之川崎氏病童，依亂數表排序，給予靜脈注射不同廠牌及不同劑量之免球蛋白，在治療前後以超音波心圖診斷冠狀動脈病灶的發生，如有心肌決氧症狀者，則做心導管檢查及冠狀動脈攝影。比較不同兩種廠牌及兩種劑量的免疫球蛋白預防冠狀動脈病變發生效果。病患依亂數表排序，共分為四組，給予靜脈注射不同廠牌及不同劑量之高劑量免疫球蛋白。第一組(33例病患)施予G牌400毫克/每公斤/每天共5天。第二組(47例病患) 施予G牌2公克/每公斤 共一劑。第三組(10例病患)施予I牌400毫克/每公斤/每天 共5天。第四組(9例病患)施予I牌2公克/每公斤共一劑。結果 結果發現：第一點，施予高劑量靜脈注射免疫球蛋白治療川崎氏病患，2公克8每公斤共一劑比400毫克/每公斤/每天共5天更能有效縮短發燒天數。第二點，對於預防冠狀動脈急性期的病變和再次接受免疫球蛋但率的比較：在急性期，廠牌(I)比廠牌(G)好，不管在任何劑量(400毫克/每公斤/每天 共5天和2公克/每公斤 共一劑)。而一次接受免疫球蛋白率，不管廠牌(I)或廠牌(G)在劑量(400毫克/每公斤/每天共5天或2公克/每公斤/每天 共5天或2公克/每公斤 共一劑)其效果都一樣。第三點，假使排除在施予高劑量靜脈注射免疫球蛋白治療之前病變率，則預防冠動脈產生病變之預防率為：第一組為50.0%，第二組為49.2%，第三組為100%，第四組為100%。結論 討論方面：第一點，第三組和救四組病例數太少，且四組組成和臨床表徵不同，在此研究當中可能產生一些誤差。第二點，在施予高劑量靜脈注射免疫球蛋白治療之前病變率高於其他研究，可能是因本院為國家級醫學中心，故轉介之病患常較為嚴重。第三點，G和I廠牌免疫球蛋白，根據產品說明，二者製備方法大同小異，需作近一步詳細配成成份分析及臨床病患治療比較，以能作出較客觀的比較結果。

Object: To evaluate the effect of different types and regimens of high-dose intravenous immune globulin (IVIG) on patients with Kawasaki Disease. Patients: From June 1994 to May 2002, 120patients who met the diagnostic criteria of Kawasaki disease (KD) at our institution were reviewed. Of them, 99 who had complete data were enrolled in this study. Before IVIG therapy, 25(25.3%) of 99 patients had coronary artery involvement. Methods: Patients with KE were given a different brand and dosage of IVIG when available in the hospital in random order. They were divided randomly into 4 groups with different types and regimens of high-dose IVIG.. Group I (33 cases)-G regimen, 400 mg/kg/day×5days; Group II (47 cases)-G regimen, 2gm/kg×1dose; Group III(10cases)- I regimen, 400mg/kg/day×5days; Group IV (9 cases)-I regimen, 2 gm/kg×1dose. Patients’ data were collected including: 1. age and sex; 2. symptoms and signs; 3. fever lasting days after IVIG; 4 echocardiographic findings (before IVIG, at acute stage, at convalescent stage, and long term follow-up); 5. retreatment with IVIG. Results: 1. There were some differences in the clinical features, including sex, age, duration of fever before administration of IVIG, and diagnostic criteria of Kawasaki Disease among the 4 groups; 2 The durations of fever lasting after administration of IVIG were 3.9±2.2,2.8±1.4,4.3±2.5, and 2.0±1.3days in Groups I, II , III and IV, respectively; 3. Two-dimensional echocardiographic evidence of coronary arterial dilatation/aneurysm detected before IVIG in Groups I, II, III and IV were, respectively, 3.4%, 40.4%, 30.0%, and 11.1%, at acute stage were 60.6%, 44.7%, 20%, and 22.2%, at convalescent stage were 12.1%, 17.0%, 0%, and 0%, and at long-term follow-up were 12.1%, 12.8%, 0%, and 0%.4. The rates of retreatment with IVIG were 9.1%, 8.5%, 10%, 11.1%in group I, II III and IV, respectively. Conclusions: 1.Treatment of Kawasaki Disease with the regimen of 2 gm/kg × one dose of IVIG had a better effect to shorten the duration of fever than that with 400 mg/kg/day × 5days. 2. G and I regimens seemed to make a difference in prevention of coronary dilation/aneurysm at acute stage, although the difference was without statistical significance; and there were no statistical differences in convalescent stage, long-term follow-up and retreatment, even for different dosages and brands. 3 If the patients with coronary abnormalities before IVIG were excluded, coronary abnormality prevention rates were 50.0%, 49.2%, 100%, and 100%, respectively, by the four different regimens of IVIG.