There have been no robust data from clinical trials to guide the clinician in the choice of therapeutic agents for the child with intravenous immunoglobulin (IVIG) resistance. The treatment regimen for IVIG-resistant patients varies between institutions, and the best option has not yet been established. Therefore, in this trial, a total of 955 patients with Kawasaki disease (KD) were selected and were initially treated with IVIG (2 g/kg), of whom 80 (8.38%) assessed as IVIG resistant were randomly divided into two groups: Group A received the second IVIG treatment (), and Group B received methylprednisolone pulse therapy (MPT, ). The whole fever time, duration of fever after retreatment, hospital days, medical costs, readmission rate, and laboratory examination difference (△) were calculated. Coronary artery lesion (CAL) outcomes were followed up over two years. Patients in the MPT group had shorter fever after retreatment and lower medical costs; more rapid declines in C-reactive protein (CRP), neutrophils (N%), and platelet (PLT) levels; and more rapid rise in sodium. However, they also probably had a higher incidence of treatment failure and CALs than the additional IVIG treatment group in the long-term follow-up. Caution is still required in the use of MPT to treat IVIG-resistant KD.

中文翻译：

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对 IVIG 耐药的川崎病患者进行甲基强的松龙脉冲治疗或额外的 IVIG

没有来自临床试验的可靠数据来指导临床医生为静脉注射免疫球蛋白 (IVIG) 抵抗的儿童选择治疗药物。IVIG耐药患者的治疗方案因机构而异，最佳选择尚未确定。因此，在本次试验中，总共选择了955名川崎病（KD）患者并进行了IVIG（2 g/kg）初始治疗，其中80名（8.38%）被评估为IVIG耐药的患者被随机分为两组： A组接受第二次IVIG治疗（), B 组接受甲泼尼龙冲击治疗 (MPT,）。计算全程发热时间、复治后发热持续时间、住院天数、医疗费用、再入院率、实验室检查差值（△）。对冠状动脉病变 (CAL) 结果进行了两年以上的随访。MPT组患者复治后发热更短，医疗费用更低；C 反应蛋白 (CRP)、中性粒细胞 (N%) 和血小板 (PLT) 水平下降更快；并且钠的升高更快。然而，在长期随访中，他们的治疗失败和 CAL 发生率也可能高于额外的 IVIG 治疗组。在使用 MPT 治疗 IVIG 耐药 KD 时仍需谨慎。