英夫利昔单抗与静脉注射免疫球蛋白治疗难治性川崎病疗效比较的Meta分析

Meta-Analysis on Comparison of Efficacy of Infliximab and Intravenous Immunoglobulin in the Treatment of Children with Refractory Kawasaki Disease

目的:比较英夫利昔单抗与静脉注射免疫球蛋白(IVIG)治疗儿童难治性川崎病(rKD)的有效性和安全性。方法:检索PubMed、Medline、the Cochrane Library、中国知网、万方、维普数据库收集英夫利昔单抗与IVIG治疗rKD疗效比较的研究,检索时限为建库至2020年3月。根据纳入标准及排除标准筛选文献、提取数据及进行质量评价,应用RevMan 5.3软件对纳入文献进行Meta分析。结果:共纳入6项研究,包括488例患儿。Meta分析结果显示,英夫利昔单抗可提高rKD治疗有效率(OR=2.45,95%CI 1.47~4.09,P=0.0006)、缩短患儿发热时间(SMD=-2.04,95%CI-3.96~-0.12,P=0.04)。两组患儿冠状动脉扩张发生率(OR=1.10,95%CI 0.62~1.95,P=0.74)、冠状动脉瘤发生率(OR=1.06,95%CI 0.52~2.17,P=0.88)、冠状动脉Z值-最大值(SMD=-0.30,95%CI-0.35~0.95,P=0.36)比较差异均无统计学意义。两组不良反应发生率比较差异无统计学意义(P>0.05)。结论:与重复给予IVIG治疗比较,英夫利昔单抗可提高rKD患儿治疗有效率、缩短发热时间,两者安全性相似,但对于心血管尚未发现明显保护作用。受样本量及文献质量限制,本研究结果尚需进一步开展大规模高质量随机对照试验加以验证。

Objective:To compare the efficacy and safety of infliximab and intravenous immunoglobulin(IVIG)in the treatment of children with refractory Kawasaki disease(rKD).Methods:PubMed,Medline,the Cochrane Library,CNKI,Wanfang and VIP database were retrieved to collect the clinical studies of comparison of infliximab and IVIG in the treatment of rKD.The retrieval time was from the establishment of the database to Mar.2022.According to the inclusion and exclusion criteria,literature was screened,data were extracted and quality was evaluated.RevMan 5.3 software was used to perform the Meta-analysis.Results:A total of 6 studies were enrolled,including 488 children.Meta-analysis showed that infliximab could improve the effective rate of rKD treatment(OR=2.45,95%CI from 1.47 to 4.09,P=0.000,6)and shorten the duration of fever(SMD=-2.04,95%CI from-3.96 to-0.12,P=0.04).There was no significant difference in the incidence of coronary artery dilatation(OR=1.10,95%CI from 0.62 to 1.95,P=0.74),incidence of coronary artery aneurysm(OR=1.06,95%CI from 0.52 to 2.17,P=0.88),Z value-maximum value of coronary artery(SMD=-0.30,95%CI from-0.35 to 0.95,P=0.36)between two groups.There was no significant difference in the incidence of adverse drug reactions between two groups(P>0.05).Conclusion:Compared with repeated administration of IVIG,infliximab can improve the treatment efficiency and shorten the duration of fever in children with rKD.The safety of the two is similar,yet no significant protective effect on cardiovascular disease has been found.Due to the limitation of sample size and literature quality,the results of this study need to be further verified by large-scale high-quality randomized controlled trials.