糖皮质激素联合静脉免疫球蛋白治疗川崎病有效性和安全性的荟萃分析  

Efficacy and safety of glucocorticoids in addition to intravenous immunoglobulin in the initial treatment of Kawasaki disease： a meta-analysis of randomized trials

作　　者：胡景伟[1] 周忠蜀[1] 杨凌[1] 郑承宁[1] 王琨蒂[1] 

机构地区：[1]卫生部中日友好医院儿科,北京100029

出　　处：《中华医学杂志》2011年第18期1259-1264,共6页National Medical Journal of China

摘　　要：目的评价糖皮质激素（GC）联合静脉免疫球蛋白（IVIG）治疗川崎病（KD）的有效性和安全性。方法按系统评价的要求，制定检索策略和纳入标准，检索14种电子文摘及全文数据库，手工检索3种日文杂志，收集GC联合IVIG治疗KD的随机对照试验。对纳入文献进行质量评价，应用RevMan5．0．23．0软件进行荟萃分析。结果共纳入3个试验，患者416例，其中GC＋IVIG组209例，IVIG组207例。GC＋IVIG组与IVIG组比较，治疗后1个月内和1个月后冠状动脉病变（CAL）发生率差异均无统计学意义[优势比（OR）：0．74，0．69；95％可信区间（c，）：0．23-2．40，0．35-1．38；P=0．62，0．30]；GC＋IVIG组发热持续时间明显短于IVIG组[加权的平均差值（WMO）：-0．93d，95％c，：-1．15～-0．70，P=0．00]；GC＋IVIG组治疗失败率低于IVIG组（9．09％比17．48％，OR：0．49，95％CI：0．28～0．86，P=0．01）；两组不良反应发生率差异无统计学意义（OR：0．81，95％c，：0．22～3．03，P=0．76）。结论目前没有证据支持在IVIG的基础上加用GC比单用IVIG能够进一步降低KD患者发生CAL的风险。在IVIG治疗的基础上，加用GC能够缩短KD患者发热时间，降低治疗失败率。Objective To evaluate the efficacy and safety of glucocorticoids （GC） plus intravenous immunoglobulin （IVIG） in the initial treatment of Kawasaki disease. Methods Fourteen electronic databases and 3 Japanese magazines were searched. Randomized controlled trials （RCT） describing the use of GC plus IVIG in the initial treatment of Kawasaki disease in children were collected. The data of methodological quality and trial information were extracted by two independent researchers. Cochrane review methodology was used for assessing the trial quality and efficacy. Each dichotomous outcome was measured in terms of odds risk （OR） while continuous outcomes shown as weighted mean differences （WMD）. And a meta-analysis was made with RevManS. 0. 23.0 software. Results A total of 416 cases in 3 trials were included. There were 209 cases in GC ＋ IVIG group and 207 cases in IVIG group. The incidence of coronary artery lesion （CAL） was not different between GC ＋ IVIG and IVIG groups within 1 month or 1 month post- treatment（OR：0.74,0. 69;95% CI：O. 23 - 2.40,0. 35 - 1.38; P = 0. 62,0. 30]. The fever duration was shorter in GC ＋ IVIG group than that in IVIG group （ WMD ： - 0. 93 d, 95% CI： - 1.15 ～ - 0. 70, P = 0. 00）. The treatment failure rate was less in GC ＋ IVIG group than IVIG group（9.09% vs 17.48%, OR： 0. 49,95% CI：O. 28 -0. 86,P =0. 01 ）. No difference in adverse events was found between two groups （ OR： 0. 81,95 % CI：O. 22 - 3.03, P = 0. 76 ）. Conclusion There is no evidence to support that GC plus IVIG can further reduce the CAL risk of KD patients. But it mac lower the treatment failure rate in KD patients.

关 键 词：黏膜皮肤淋巴结综合征 糖皮质激素类 免疫球蛋白类 静脉内 有效性 安全性 

分 类 号：R725.4[医药卫生—儿科]