糖皮质激素对川崎病治疗效果的Meta分析

A Meta-analysis on the Effect of Corticosteroid Therapy for Coronary Artery Lesion and Clinical Course in Kawasaki Disease

目的评价糖皮质激素治疗川崎病的疗效及安全性。方法检索Cochrane图书馆、Medline、CNKI等国内外大型专业数据库及相关儿科学杂志，初筛文献，经全文浏览确定最终纳入文献。通过Meta分析，比较糖皮质激素与丙种球蛋白治疗川崎病在冠状动脉病变发生率、退热时间、CRP水平的变化及治疗无反应率方面的差异。结果初筛得到22篇文献，经过严格筛选最终纳入11篇文献，其中7篇将糖皮质激素联合丙种球蛋白用于川崎病的初始治疗，4篇将糖皮质激素用于对丙球无反应患儿的治疗即追加治疗。经Meta分析，①追加治疗组、激素联合初始治疗组急性期、治疗1个月随访后与丙球组比较，冠状动脉病变发生率差异均无统计学意义；②热程比较：激素原发治疗组比丙球组热退时问缩短；差异有统计学意义；③治疗无反应率的比较；在川崎病原发治疗时，激素联合丙球与单用丙球相比，治疗的无反应率明显减少，差异有统计学意义。结论该研究结果提示，激素联合丙球用于川崎病初始治疗或追加治疗时，与常规丙球治疗比较，冠状动脉病变发生率及冠状动脉瘤发生率方面无差异．且可缩短热程，使炎症指标（CRP）下降更快，并可降低治疗无反应率或需丙球再治疗率。目前仍无单独应用激素作为川崎病初始治疗的依据，但对耐丙球或高危川崎病患儿可选择性慎用。要进一步验征激素疗效，以指导临床治疗，需更多大样本、多中心的随机对照研究。

Objective To investigate the efficacy of corticosteroid in Kawasaki Disease through comparing it with intravenous immunoglobulin. Methods We included all randomised or quasirandomised control trials related by searching the Medline,the Cochrane Central Register of Controlled Trials,EMBASE,CNKI and a database in Japan,as well as hand searches of selected references.Data collection and Meta-analysis were performed to evaluate the effect of corticosteroid. Results 11 studies were finally included,7 of which studied the effect of corticosteroid therapy for primary treatment in KD,and 4 studied the effect for additional treatment to [VIG- resistent patients.Meta-analysis of these studies revealed a significant reduction in the rates of initial treatment failure among patients who received corticosteroid therapy plus aspirin ＋ IVI（3 compared with aspirin ＋ IVIG alone,moreover,the duration of fever was shorter, CRP decreased more rapidly in the corticosteroid group than in the control group.However there was no significant reduction in the incidence of coronary artery lesions orcoronary aneurysms in the corticosteroid group. Conclusions Corticosteroid therapy combined with IVI（3 in primary treatment or administered to those IVIG-resistent improved clinical course without increasing coronary artery lesions in children with acute KD,corticosteroid can be considered as a primary treatment for high-risk KD patients or IVIG-resistent ones.