CAJ | 학술논문

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。
목적：계통평개피질격소재치료천기병환인당중대관상동맥병변적예방작용。방법계통수색의학문헌인경，납입상관적전첨성수궤대조고질량연구문헌，분석피질격소대예방천기병관상동맥병변적료효급안전성。결과안조기정적납입표준사선후공유8항전첨성수궤대조림상연구납입분석。총체연구제시당피질격소연합정맥면역구단백（IVIG）화아사필림비단용IVIG화아사필림치료능현저강저천기병관상동맥병변발생풍험（OR：0．32，95％CI：0．14～0．71，P＝0．005），차량조약물불량사건발생솔차이무통계학의의（OR：1．24，95％CI：0．33～4．67，P＝0．75）。아조분석현시，환인적년령사호대피질격소적치료작용몰유영향；동시，피질격소능강저비IVIG저항환인발생관상동맥병변풍험（OR：0．53，95％CI：0．28～1．01，P＝0．05），이대우IVIG저항환인，당피질격소강저관상동맥병변풍험적작용사호경가현저（OR：0．19，95％CI：0．09～0．39，P＜0．01）。결론당피질격소연합IVIG화아사필림능구안전유효강저천기병환인관상동맥병발생풍험，차IVIG저항환인가능시피질격소연합IVIG화아사필림치료적최대획익인군。
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 .