不同剂量丙种球蛋白治疗川崎病的疗效的Meta分析

Treatment of Kawasaki disease by different doses of immunoglobulin: a Mata analysis of therapeutic effects

摘要:

目的：评价不同剂量丙种球蛋白治疗川崎病的临床疗效和安全性。方法：计算机检索PubMed、EMBASE、Cochrane图书馆、CNKI、VIP和万方等数据库。纳入不同剂量丙种球蛋白治疗川崎病的随机对照试验（RCT）研究，并对其进行质量评价，用Rev Man 5.0软件进行Meta分析。结果：纳入28个RCT共2596例患儿。Meta分析显示：① 1 g/(kg?d)×1~2 d vs 2 g/(kg?d)单次：在急性和亚急性期、6个月、1年的冠状动脉异常、不良反应方面及退热时间方面差异无统计学意义；② 1 g/(kg?d)×1~2 d vs 400 mg/(kg?d)×4~5 d：1 g/(kg?d)×1~2 d 组比400 mg/(kg?d)×4~5 d组退热时间短，差异有统计学意义;在急性期、6个月冠状动脉异常、不良反应方面两组差异均无统计学意义；③ 2 g/(kg?d)单次 vs 400 mg/(kg?d)×4~5 d：2 g/(kg?d) 单次给药在急性期、6个月冠状动脉损伤的发生比率低、退热时间短,差异有统计学意义，在亚急性期、1年冠状动脉异常、不良反应方面差异无统计学意义。结论：丙种球蛋白1 g/(kg?d)×1~2 d组与2 g/(kg?d)单次组疗效相似。而1 g/(kg?d)×1~2 d组与2 g/(kg?d)单次组在退热时间方面均优于400 mg/(kg?d)×4~5 d组。

Abstract:

OBJECTIVE: To assess the therapeutic effects and safety of different doses of immunoglobulin in the treatment of Kawasaki disease. METHODS: The papers related to the treatment of Kawasaki disease were electronically searched in the databases of PubMed, EMBASE, Cochrane Library, CNKI, VIP and Wanfang. Randomized clinical trials (RCT) on the treatment of Kawasaki disease with different doses of immunoglobulin were included and assessed for quality. A Mata analysis was performed by RevMan 5.0. RESULTS: Twenty-eight RCTs involved 2596 cases were included. The results of Meta analysis showed that there were no significant differences in the incidences of coronary artery injuries at various phases, adverse effects and fever disappearance time between the immunoglobulin treatment groups at the doses of 1 g/(kg?d) for 1-2 days and 2 g/(kg?d) for single use. The fever disappearance time in the immunoglobulin treatment group at the dose of 1 g/(kg?d) for 1-2 days was significantly shorter than that in the immunoglobulin treatment group at the dose of 400 mg/(kg?d) for 4-5 days, but there were no significant differences in the incidences of coronary artery injuries at the acute phase and 6 months after treatment and adverse effects between the two groups. The incidence of coronary artery injuries at the acute phase and 6 months was lower and the fever disappearance time was shorter in the immunoglobulin treatment group at the dose of 2 g/(kg?d) for single use than those in the immunoglobulin treatment group at the dose of 400 mg/(kg?d) for 4-5 days, but there were no significant differences in the incidences of coronary artery injuries at the subacute phase and 12 months after treatment and adverse effects between the two groups. CONCLUSIONS: There are similar therapeutic effects for Kawasaki disease between the immunoglobulin treatment groups at the doses of 1 g/(kg?d) for 1-2 days and 2 g/(kg?d) for single use. The fever disappearance time in the two groups is shorter than that in the treatment group at the dose of 400 mg /(kg?d) for 4-5 days.