【摘要】 目的:目前治疗川崎病的标准方法是使用高剂量丙种球蛋白(2 g.kg-1)和阿司匹林,但是仍有10%～20%的患儿对丙种球蛋白无反应。在探讨丙种球蛋白无反应性川崎病的继续治疗中,本研究利用循证医学的Meta分析方法,比较改用糖皮质激素与再次静脉注射丙种球蛋白两种治疗方法的优缺点。方法:共选用了6篇有关丙种球蛋白无反应性川崎病两种治疗方案对比治疗的文献,利用Meta分析对冠状动脉损害、患儿发热天数、CRP3个方面进行统计后比较。结果:6个研究组中包括156例患者,其中有89例患儿给予糖皮质激素治疗,67例患儿给予丙种球蛋白治疗。结果为:糖皮质激素与丙种球蛋白在冠状动脉损伤比较时OR=0.65(95%CI,0.29～1.45)>0,菱形与垂直线相交;发热天数比较时WMD=-1.91(95%CI,-2.88～-0.95)<0,菱形完全位于垂直线的左侧;CRP比较时WMD=-3.94(95%CI,-5.42～-2.45)<0菱形完全位于垂直线的左侧。因此糖皮质激素与再次使用丙种球蛋白在减少冠脉损伤疗效上无显著性差异,但在退热和CRP降低方面的疗效上具有显著性差异。结论:丙种球蛋白无反应川崎病患儿换用糖皮质激素比再次使用丙种球蛋白能够起到更好的治疗作用,而且在经济上花费更少。更多还原

【Abstract】 OBJECTIVE The current standard method of treatment of Kawasaki disease is the use of high doses of gamma globulin(2 g·kg-1) and aspirin.This study will use the Meta analysis of the evidence-based medicine to explore the advantages and disadvantages of either glucocorticosteroid or repeated intravenous gamma globulin in treating Kawasaki disease after failure of initial treatment.METHODS This study selected six research groups which were related to the patients with Kawasaki disease who failed to respond to the initial intravenous gamma globulin treatment;then used the Meta analysis to compare the two kinds of treatment in the aspects of damage of the coronary arteries,fever duration and serum CRP levels.RESULTS 6 research groups included 156 patients for analysis.89 patients were received intravenous glucocorticosteroid and 67 cases were given repeated intravenous gamma globulin.In comparison of intravenous glucocorticosteroid versus repeated intravenous gamma globulin,OR for the damage of the coronary arteries was 0.65(95%CI,0.29-1.45)>0 with rhombus intersection with the vertical line,WMD for fever duration was-1.91(95%CI,-2.88——0.95)<0 with rhombus situated to the left side of the vertical line.WMD for the serum CRP levels was-3.94(95%CI,-5.42——2.45)<0 with rhombus entirely situated to the left side of the vertical line.Therefore,both efficacy in reducing coronary artery injury were no significant difference,but in terms of fever and reduce the effect of CRP were the significant differences.CONCLUSION Glucocorticoid can play a better therapeutic effect and spend less in the economy than re-use of gamma globulin in the failure of initial treatment of Kawasaki disease.更多还原