糖皮质激素联合免疫球蛋白用于川崎病初始治疗有效性的Meta分析  

Efficacy of glucocorticoids combined with immunoglobulin in initial treatment of Kawasaki disease: a Meta analysis

作　　者：李静[1] 王博龙[1] 冯瑞冰[2] 李国栋[3] 

机构地区：[1]宜春学院化学与生物工程学院,江西宜春336000 [2]澳门大学中华医药研究院,澳门氹仔000853 [3]广东医学院药学院,广东湛江524023

出　　处：《中国当代儿科杂志》2016年第6期527-533,共7页Chinese Journal of Contemporary Pediatrics

摘　　要：目的系统评价糖皮质激素(GCs)联合静脉注射免疫球蛋白(IVIG)用于川崎病(KD)初始治疗的有效性和安全性。方法计算机检索MEDLINE数据库、PubMed数据库、CNKI、万方数据库、维普电子期刊全文数据库等,收集GCs联合IVIG初始治疗儿童KD的前瞻性对照研究或回顾性对照研究,检索时间为各数据库建库至2016年3月。由2位研究者独立筛选文献、提取资料并对纳入文献进行质量评价后,采用RevMan5.2软件进行Meta分析。结果共纳入11篇文献,均为英文文献,其中前瞻性研究7项,回顾性研究4项。Meta分析结果显示:与单用IVIG相比,GCs联合IVIG组的冠状动脉损害(CAL)发生率更低(OR=0.44,95%CI:0.23~0.86,P=0.02),发热持续时间更短(MD=-1.66,95%CI:-2.32^-1.01,P<0.00001),且首次治疗未反应率低于单用IVIG组(OR=0.37,95%CI:0.27~0.51,P<0.00001)。两组复发率和不良反应发生率比较差异均无统计学意义。结论 GCs联合IVIG初始治疗KD能降低患儿CAL发生率及首次治疗未反应率,缩短发热时间,且不增加复发率和不良反应的发生。ObjectiveTo systematically investigate the efifcacy and safety of glucocorticoids （GCs） combined with intravenous injection of immunoglobulin （IVIG） in the initial treatment of Kawasaki disease （KD）.Methods MEDLINE Database, PubMed Database, CNKI, Wanfang Data, and VIP Database were searched to collect prospective or retrospective controlled studies on the combination of GCs and IVIG as the initial treatment of KD, which were published up to March 2016. Two investigators independently screened the literature, extracted data, and assessed the quality of the articles included. Then, a Meta analysis was performed using RevMan 5.2 software.ResultsA total of 11 articles in English were included, with 7 prospective studies and 4 retrospective studies. The results of the Meta analysis showed that compared with the group using IVIG alone, the combination group had a significantly lower incidence rate of coronary artery lesion （CAL） （OR=0.44,95%CI0.23-0.86,P=0.02） and a signiifcantly shorter duration of fever （MD=-1.66, 95%CI -2.32 to -1.01,P〈0.00001）. The combination group had a signiifcantly lower rate of no response to initial treatment than the IVIG alone group （OR=0.37, 95%CI 0.27-0.51,P〈0.00001）. The recurrence rate of KD and the incidence rate of adverse events showed no signiifcant differences between the two groups.ConclusionsGCs combined with IVIG as the initial treatment for KD can reduce the incidence rate of CAL and the rate of no response to initial treatment and shorten the duration of fever, and does not increase the recurrence rate of KD and the incidence rate of adverse events.

关 键 词：川崎病 糖皮质激素 冠状动脉损伤 免疫球蛋白 META分析 儿童 

分 类 号：R725.4[医药卫生—儿科]