抗-D免疫球蛋白治疗儿童免疫性血小板减少症疗效的Meta分析

目的采用Meta分析方法评估抗-D免疫球蛋白(anti-D)治疗儿童新近诊断的免疫性血小板减少症(ITP)的临床疗效及安全性。方法检索PubMed、EMBASE、Cohrane Library、Ovid、中国知网及万方数据库,收集相关的随机对照试验(RCT)文献,检索时间均为建库至2017年4月,采用Review Manager 5.3软件进行Meta分析。结果有7篇RCT文献符合纳入标准。Meta分析结果显示,在治疗72 h、7 d后anti-D组血小板(PLT)20×10~9/L的患儿百分比低于静脉用免疫球蛋白(IVIG)组(P0.05);anti-D 50μg/kg组与IVIG组治疗24 h、72 h及7 d后的PLT计数比较差异无统计学意义(P0.05);anti-D 50μg/kg组与anti-D 75μg/kg组治疗24 h、7 d后的PLT计数比较差异无统计学意义(P0.05)。治疗后anti-D组比IVIG组血红蛋白含量下降更明显,但均不需要输血。anti-D组与IVIG组均未出现严重不良反应。结论静脉注射anti-D治疗儿童急性ITP在提高PLT计数方面效果可能与IVIG相同,但在治疗后PLT上升的反应速度方面效果可能略差于IVIG。使用剂量为50μg/kg和75μg/kg的anti-D疗效可能相当。使用推荐剂量的anti-D治疗ITP是安全的。

Clinical effect of anti-D immunoglobulin in treatment of childhood immune thrombocytopenia:a Meta analysis

Objective To investigate the clinical effect and safety of anti-D immunoglobulin (anti-D) in the treatment of children with newly diagnosed acute immune thrombocytopenia (ITP) through a Meta analysis. Methods PubMed, EMBASE, Cohrane Library, Ovid, CNKI, and Wanfang Data were searched for randomized controlled trials (RCTs) published up to April 2017. Review Manager 5.3 was used for the Meta analysis. Results Seven RCTs were included. The Meta analysis showed that after 72 hours and 7 days of treatment, the intravenous immunoglobulin (IVIG) group had a significantly higher percentage of children who achieved platelet count >20×109/L than the anti-D group (P<0.05). There were no significant differences in platelet count after 24 hours, 72 hours, and 7 days of treatment between the anti-D (50 μg/kg) group and the IVIG group (P>0.05), and there were also no significant differences in platelet count after 24 hours and 7 days of treatment between the 50 μg/kg and 75 μg/kg anti-D groups (P>0.05). The anti-D group had a significantly greater reduction in the hemoglobin level than the IVIG group after treatment, but did not need transfusion. No children in the anti-D group or the IVIG group experienced serious adverse reactions. Conclusions Intravenous injection of anti-D may have a similar effect as IVIG in improving platelet count in children with acute ITP, but it may be slightly inferior to IVIG in the rate of platelet increase after treatment. The anti-D dose of 50 μg/kg may have a similar effect as 75 μg/kg. The recommended dose of anti-D for treatment of ITP is safe.