中国循证医学杂志

中国循证医学杂志

川崎病接受首次静脉使用免疫球蛋白标准剂量后病情反应情况与治疗前实验室指标相关性的 Meta 分析

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目的系统评价川崎病(KD)患者接受首次静脉使用免疫球蛋白(IVIG)标准剂量后病情反应情况与治疗前实验室指标的相关性。方法计算机检索 PubMed、EMbase、The Cochrane Library、CBM、CNKI、VIP 和 WanFang Data,搜集 KD 接受首次静脉使用 IVIG 标准剂量后病情反应情况与治疗前实验室指标相关性的病例-对照研究,检索时限均为建库至 2017 年 12 月 31 日。由 2 位评价者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用 RevMan 5.3 软件进行 Meta 分析。结果共纳入 30 个研究。Meta 分析结果显示,IVIG 无反应型 KD 患者的 Hb 水平[SMD=–0.21,95%CI(–0.32,–0.09),P<0.001]、ALB 水平[SMD=–0.68,95%CI(–0.90,–0.47),P<0.001]、血钠浓度[SMD=–0.64,95%CI(–1.01,–0.27),P<0.001]均低于有反应组;而 ALT 水平[SMD=0.74,95%CI(0.36,1.13),P <0.001]、AST 水平[SMD=0.61,95%CI(0.24,0.99), P=0.001]和 CRP 水平[SMD=0.63,95%CI(0.38,0.87),P<0.001]均高于有反应组。结论现有证据表明,IVIG 无反应型 KD 可能与低 Hb、低 ALB、低血钠和高 CRP、高 ALT、高 AST 有关。受纳入研究质量和数量的限制,上述结论尚需开展更多高质量研究进一步验证。

ObjectiveTo systematically review the response of Kawasaki disease (KD) after an initial standard dose of intravenous immunoglobulin (IVIG) therapy and routine laboratory indexes.MethodsWe searched PubMed, EMbase, The Cochrane Library, CBM, CNKI, VIP and WanFang Data databases to collect case-control studies about the correlation between response of KD after an initial standard dose of IVIG therapy and routine laboratory indexes till 31st December 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. A meta-analysis was performed by using RevMan 5.3 software.ResultsThirty studies were included. The results of meta-analysis demonstrated that the levels of hemoglobin (Hb) (SMD=–0.21, 95%CI –0.32 to –0.09, P<0.001), serum albumin (ALB) (SMD=–0.68, 95%CI –0.90 to –0.47,P<0.001) and serum sodium (SMD=–0.64, 95%CI –1.01 to –0.27,P<0.001) in IVIG non-responsiveness group were significantly lower than those in IVIG responsiveness group. The levels of alanine aminotransferase (ALT) (SMD=0.74, 95%CI 0.36 to 1.13,P<0.001), aspartate aminotransferase (AST) (SMD=0.61, 95%CI 0.24 to 0.99,P=0.001) and C-reactive protein (CRP) (SMD=0.63, 95%CI 0.38 to 0.87, P<0.001) in IVIG non-responsiveness group were higher than those in the IVIG responsiveness group.ConclusionThe current evidence shows that low levels of Hb, ALB and serum sodium and high levels of CRP, ALT, and AST are risk factors of IVIG non- responsiveness in KD. Due to limited quality and quantity of included studies, more high-quality studies are needed to verify the conclusion.

关键词: IVIG; 川崎病; 无反应型; 病例-对照研究; 系统评价; Meta 分析

Key words: IVIG; Kawasaki disease; Non-response; Case-control study; Systematic review; Meta-analysis

引用本文: 刘卓勋, 温晓莹, 郑燕霞, 许尤佳, 杨京华. 川崎病接受首次静脉使用免疫球蛋白标准剂量后病情反应情况与治疗前实验室指标相关性的 Meta 分析. 中国循证医学杂志, 2018, 18(4): 347-353. doi: 10.7507/1672-2531.201703037 复制

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