儿童再发川崎病临床特征的Meta分析

Clinical features of children with recurrent Kawasaki disease: a Meta analysis

摘要:

目的 探讨儿童再发川崎病（KD）的临床特点，以提高对再发KD的认识。方法 检索PubMed、Web of Science、Embase、中国知网、万方医学网和中国科技期刊数据库中关于儿童再发KD与初发时临床特点的对照研究，根据纳入、排除标准筛选文献，采用RevMan 5.3软件进行Meta分析。根据异质性检验结果选择相应效应模型进行数据合并，计算各观察指标合并比值比（OR）或加权均数差（WMD）及其95%CI。结果 最终纳入9个病例对照研究，KD患儿样本总量为12 059例，其中再发KD患儿206例（男127例，占61.7%；女79例，占38.3%）。Meta分析结果显示，与初发时相比，再发时发热时程缩短（WMD=-1.81，95%CI：-2.99~-0.64），手足硬肿率降低（OR=0.46，95%CI：0.26~0.80），差异均具有统计学意义（P < 0.05）；KD患儿再发时与初发时冠状动脉病变发生率的比较差异无统计学意义（OR=1.34，95%CI：0.84~2.14，P=0.22）。结论 目前证据显示再发KD患儿热程更短，手足硬肿率较低；KD再发以男童多见；再发患儿冠状动脉病变发生风险未见明显增高。

Abstract:

Objective To study the clinical features of children with recurrent Kawasaki disease (KD). Methods PubMed, Web of Science, Embase, CNKI, Wanfang Med Online, and Weipu Data were searched for case-control studies on the clinical features of initial and recurrent KD. The articles were screened according to the inclusion and exclusion criteria. RevMan 5.3 software was used to perform the Meta analysis. Effect models were selected based on the results of heterogeneity test, and then pooled OR or weighted mean difference (WMD), and their 95% CI were calculated. Results A total of 9 case-control studies were included, with 12 059 children with KD in total, among whom 206 children had recurrent KD (127 boys/61.7%; 79 girls/38.3%). The results of the Meta analysis showed that compared with the initial KD onset, the children with recurrent KD had a shorter duration of fever (WMD=-1.81, 95%CI:-2.99 to -0.64) and a lower proportion of children with swelling of the hands and feet (OR=0.46, 95%CI:0.26 to 0.80). There was no significant difference in the incidence rate of coronary artery lesions between recurrent KD and initial KD (OR=1.34, 95%CI:0.84 to 2.14). Conclusions Current evidence shows that children with recurrent KD tend to have a shorter duration of fever and a lower incidence of swelling of the hands and feet. KD recurrence is more common in boys. Current evidence does not show an increased risk of developing coronary artery lesions in children with recurrent KD.