不同药物方案治疗儿童川崎病疗效和安全性的网状Meta分析
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篇名: 不同药物方案治疗儿童川崎病疗效和安全性的网状Meta分析
TITLE: Network meta-analysis of the efficacy and safety of different drug regimens in the treatment of children with Kawasaki disease
摘要: 目的 评价不同药物治疗方案用于儿童川崎病(KD)的疗效和安全性,为临床治疗提供循证参考。方法计算机检索theCochraneLibrary、Medline、Embase、CINAHL、WebofScience、ProQuest、Google学术、中国知网、万方数据、百度学术数据库和世界卫生组织国际临床试验注册平台、ClinicalTrials.gov,收集在标准静脉注射免疫球蛋白(IVIG)疗法基础上给予糖皮质激素或环孢素或肿瘤坏死因子α(TNF-α)抑制剂(试验组)对比标准IVIG疗法(对照组)的随机对照试验(RCT),检索时限为建库至2023年2月28日。筛选文献、提取资料、评价文献质量后,采用Stata14.2软件进行网状Meta分析。结果共纳入10项RCT,共计1323例患儿;涉及6种干预措施,分别为标准IVIG疗法、糖皮质激素疗法、环孢素疗法、TNF-α抑制剂疗法、补救性糖皮质激素疗法和补救性TNF-α抑制剂疗法。网状Meta分析结果显示,使用糖皮质激素疗法患儿的4~8周冠状动脉瘤(CAA)发生率显著低于使用标准IVIG疗法和TNF-α抑制剂疗法患儿,使用补救性糖皮质激素疗法、补救性TNF-α抑制剂疗法患儿的4~8周CAA发生率均较使用糖皮质激素疗法患儿显著升高;其他干预措施间比较,差异均无统计学意义(P>0.05);该发生率的网状Meta排序由低到高为糖皮质激素疗法<环孢素疗法<标准IVIG疗法<补救性TNF-α抑制剂疗法<补救性糖皮质激素疗法<TNF-α抑制剂疗法。使用环孢素疗法患儿的初始IVIG抵抗发生率显著低于使用标准IVIG疗法患儿;其他干预措施间比较,差异均无统计学意义(P>0.05);该发生率的网状Meta排序由低到高为环孢素疗法<糖皮质激素疗法<TNF-α抑制剂疗法<标准IVIG疗法。各干预措施间的不良反应发生率比较,差异均无统计学意义(P>0.05);该发生率的网状Meta排序由低到高为补救性TNF-α抑制剂疗法<TNF-α抑制剂疗法<标准IVIG疗法<糖皮质激素疗法<环孢素疗法。结论初始阶段给予糖皮质激素可显著减少KD患儿4~8周CAA的发生风险,给予环孢素可显著改善初始IVIG抵抗,在补救阶段使用TNF-α抑制剂的不良反应发生率可能最低。
ABSTRACT: OBJECTIVE To evaluate the efficacy and safety of different drug regimens in the treatment of children with Kawasaki disease, and to provide evidence-based reference for clinical treatment. METHODS Retrieved from the Cochrane Library, Medline, Embase, CINAHL, Web of Science, ProQuest, Google Scholar, CNKI, Wanfang Data, Baidu academic database, World Health Organization International Clinical Trials Registration Platform and ClinicalTrials. gov, randomized controlled trials (RCTs) about intravenous immunoglobulin (IVIG)+glucocorticoid or cyclosporine or tumor necrosis factor-alpha (TNF-α) blocker (trial group) versus standard IVIG therapy (control group) were collected from the establishment of the database to Feb. 28th, 2023. After screening the literature, extracting data, and evaluating the quality of the literature, Stata 14.2 software was used for network meta-analysis. RESULTS Ten RCTs with a total of 1 323 participants involving six measures were included: standard IVIG therapy, glucocorticoid therapy,cyclosporine therapy, TNF- α blocker therapy, remedial glucocorticoid therapy and remedial TNF- α blocker therapy. Results of network meta-analysis showed that the incidence of coronary artery aneurysms (CAA) at 4-8 weeks was significantly lower in patients receiving glucocorticoid therapy than receiving standard IVIG therapy and TNF-α blocker therapy. The incidences of CAA at 4-8 weeks in children treated with remedial glucocorticoid therapy and remedial TNF- α blocker therapy were significantly higher than those treated with glucocorticoid therapy; there was no significant difference in the incidence of CAA at 4-8 weeks among other interventions (P> 0.05); network meta-order of the incidence was glucocorticoid therapy<cyclosporine therapy<standard IVIG therapy<remedial TNF-α blocker therapy<remedial glucocorticoid therapy<TNF-α blocker therapy. The incidence of initial IVIG resistance in children receiving cyclosporine therapy was significantly lower than those receiving standard IVIG therapy; there was no significant difference in the incidence of initial IVIG resistance among other interventions (P>0.05); network meta-order of the incidence was cyclosporine therapy<glucocorticoid therapy<TNF-α blocker therapy<standard IVIG therapy. There was no significant difference in the incidence of ADR among different interventions (P>0.05); network meta-order of the incidence was remedial TNF-α blocker therapy<TNF-α blocker therapy<standard IVIG therapy<glucocorticoid therapy<cyclosporine therapy. CONCLUSIONS Glucocorticoid therapy at the initial treatment can significantly reduce the risk of CAA at 4-8 weeks in children with Kawasaki disease; cyclosporine has a significant effect on improving initial IVIG resistance, and the use of TNF-α blocker in the remedial stage may have the lowest incidence of adverse reactions.
期刊: 2023年第34卷第22期
作者: 陈昶;黄小惠;吕智濠;黄裕立
AUTHORS: CHEN Chang,HUANG Xiaohui,LYU Zhihao,HUANG Yuli
关键字: 儿童川崎病;静脉注射免疫球蛋白抵抗;糖皮质激素;环孢素;肿瘤坏死因子α抑制剂;网状Meta分析
KEYWORDS: pediatric Kawasaki disease; intravenous immunoglobulin resistance; glucocorticoid; cyclosporine; tumor necrosis
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