糖皮质激素治疗降低川崎病患儿冠状动脉病变发生风险的Meta分析

目的：系统评价皮质激素在治疗川崎病患儿当中对冠状动脉病变的预防作用。方法系统搜索医学文献引擎，纳入相关的前瞻性随机对照高质量研究文献，分析皮质激素对预防川崎病冠状动脉病变的疗效及安全性。结果按照既定的纳入标准筛选后共有8项前瞻性随机对照临床研究纳入分析。总体研究提示糖皮质激素联合静脉免疫球蛋白（IVIG）和阿司匹林比单用IVIG和阿司匹林治疗能显著降低川崎病冠状动脉病变发生风险（OR：0．32，95％CI：0．14～0．71，P＝0．005），且两组药物不良事件发生率差异无统计学意义（OR：1．24，95％CI：0．33～4．67，P＝0．75）。亚组分析显示，患儿的年龄似乎对皮质激素的治疗作用没有影响；同时，皮质激素能降低非IVIG抵抗患儿发生冠状动脉病变风险（OR：0．53，95％CI：0．28～1．01，P＝0．05），而对于IVIG抵抗患儿，糖皮质激素降低冠状动脉病变风险的作用似乎更加显著（OR：0．19，95％CI：0．09～0．39，P＜0．01）。结论糖皮质激素联合IVIG和阿司匹林能够安全有效降低川崎病患儿冠状动脉并发生风险，且IVIG抵抗患儿可能是皮质激素联合IVIG和阿司匹林治疗的最大获益人群。

Updated evidence based medical research on corticosteroid treatment in preventing coronary abnormalities for children with Kawasaki disease

Objective To systematically evaluate the efficacy of corticosteroids in the management of Kawasaki disease(KD) and prevention of coronary complication by performing a Meta‐analysis .Methods We searched medical databases for randomized con‐trolled clinical trials (RCT ) comparing the efficacy of corticosteroids combined with intravenous immunoglobulin (IVIG) and aspi‐rin versus IVIG plus aspirin alone .Results Eight RCTs were included by using predefined inclusion criteria .Overall ,Meta‐analysis found that corticosteroids combined with IVIG and aspirin significantly reduced the risk of coronary abnormalities as compared to IVIG plus aspirin alone (OR:0 .32 ,95% CI:0 .14 -0 .71 ,P=0 .005) without increased risk of drug‐related adverse events (OR:1 .24 ,95% CI:0 .33-4 .67 ,P=0 .75) .Subgroup analysis showed that age seemed had little effect on the efficacy of corticosteroids ;further analysis still demonstrated that corticosteroids could decrease the risk of coronary abnormalities among unselected KD chil‐dren (OR:0 .53 ,95% CI:0 .28-1 .01 ,P=0 .05) ,and this positive effect seemed more pronounced among IVIG resistant KD chil‐dren (OR:0 .19 ,95% CI:0 .09 -0 .39 ,P<0 .01) .Conclusion Strategy using corticosteroids combined with conventional therapy could reduce the risk of coronary abnormalities for KD children ,and the IVIG resistant patients may benefit the most .