英夫利昔单抗治疗丙种球蛋白无反应型川崎病有效性及安全性的系统评价及Meta分析

Efficacy and Safety of Infliximab in the Treatment of Intravenous Immunoglobulin Resistant Kawasaki Disease:A Systematic Review and Meta-Analysis

目的:系统评价英夫利昔单抗(IFX)治疗静脉注射丙种球蛋白(IVIG)无反应型川崎病(KD)的有效性及安全性。方法:计算机检索PubMed、the Cochrane Library、Medline、中国知网、万方数据库和中国生物医学文献数据库,收集各数据库从建库至2020年6月有关IFX治疗IVIG无反应型KD的文献,对符合纳入标准的文献应用RevMan 5.3进行Meta分析。结果:共纳入5篇文献,包括IFX治疗组(81例)和再次IVIG治疗对照组(211例)。Meta分析结果显示,IVIG无反应型KD患儿在首次IVIG治疗无反应后,IFX治疗组退热率明显高于再次IVIG治疗对照组,差异有统计学意义(RR=1.38,95%CI 1.20~1.59,P<0.01),但在冠状动脉损害(CALs)发生率及不良事件发生率方面两组患儿比较差异均无统计学意义(P>0.05)。结论:目前证据表明,IVIG无反应型KD患儿在首次IVIG治疗无反应后,应用IFX治疗较再次应用IVIG治疗能更有效地控制体温,但两者在CALs发生率及不良事件发生率方面比较差异无统计学意义。

Objective:To review the efficacy and safety of infliximab(IFX)in the treatment of intravenous immunoglobulin(IVIG)resistant Kawasaki disease(KD).Methods:PubMed,the Cochrane Library,Medline,CNKI,Wanfang Database and Chinese Biological Medical Literature Databases were searched by computer,and the articles about IFX in the treatment of IVIG-resistant KD from the establishment of each database to June 2020 were collected.Meta-analysis was performed on the articles that met the inclusion criteria using Review Manager 5.3.Results:A total of 5 articles were included,which was divided into IFX treatment group(81 cases)and re-IVIG treatment control group(211 cases).The results of Meta-analysis showed that the antipyretic rate in the IFX treatment group was significantly higher than that in the control group after the first IVIG treatment(RR=1.38,95%CI 1.20-1.59,P<0.01),but there was no significant difference in the incidence of coronary artery lesions(CALs)and adverse events between the two groups(P>0.05).Conclusion:At present,the evidence shows that after the first IVIG treatment,IFX treatment can control body temperature more effectively than IVIG treatment in children with IVIG resistant KD,but there is no significant difference in the incidence of CALs and adverse events between the two groups.