切换至 "中华医学电子期刊资源库"

中华妇幼临床医学杂志(电子版) ›› 2005, Vol. 01 ›› Issue (02) : 87 -92. doi: 10.3877/cma.j.issn.1673-5250.2005.02.106

论著

糖皮质激素在川崎病治疗中作用的循证医学研究
刘瀚旻, 高举, 王晓琴   
  1. 四川大学华西第二医院儿科(成都,610041)
  • 出版日期:2005-08-25
  • 基金资助:
    本课题为四川大学华西医院,中国循证医学/Cochrane中心及CMB循证医学资助项目(98-680)

The evidence-based research of corticosteroids treatment of Kawasaki disease

Han-min LIU, Ju GAO, Xiao-qing WANG   

  1. Pediatric Department, West China Second University Hospital, Sichuan University, Chengdu 610041, China
  • Published:2005-08-25
引用本文:

刘瀚旻, 高举, 王晓琴. 糖皮质激素在川崎病治疗中作用的循证医学研究[J]. 中华妇幼临床医学杂志(电子版), 2005, 01(02): 87-92.

Han-min LIU, Ju GAO, Xiao-qing WANG. The evidence-based research of corticosteroids treatment of Kawasaki disease[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2005, 01(02): 87-92.

目的

通过循证医学方法研究肾上腺皮质激素在川崎病治疗中的作用。

方法

采用循证医学方法,检索国内外5种大型专业数据库,筛选出随机或半随机对照研究的文献,再人工筛查确定适宜文献。通过Meta分析,比较激素与丙种球蛋白治疗川崎病在退热时间和冠状动脉病变发生率方面的差异。

结果

初筛得到443篇文献。经过人工检索,8篇文献符合要求而被纳入标准。其中,3篇文献共有49例川崎病患儿接受甲基强的松龙治疗,5篇文献共有406例患儿接受强的松治疗。对照组共有33例接受静脉丙种球蛋白治疗,435例接受阿司匹林治疗。各组间患儿性别、年龄、病程差异无显著意义。①甲基强的松龙组(3篇文献):24例发生冠状动脉病变,对照组18例发生,两组病变发生率差异无显著意义。在退热方面,1篇文献显示甲基强的松龙组发热时间明显较丙种球蛋白组缩短,差异有显著意义;2篇文献显示差异无显著意义。②强的松组(8篇文献):28例发生冠状动脉瘤,阿司匹林对照组11例发生,3篇文献提示强的松组冠状动脉瘤发生率明显高于对照组。强的松组76例发生冠状动脉扩张,对照组75例发生,3篇文献提示强的松组冠状动脉扩张发生率明显高于对照组,2篇文献提示强的松组冠状动脉扩张发生率略低于对照组,但差异无显著意义。

结论

目前的研究资料显示,激素治疗与丙种球蛋白治疗川崎病在冠状动脉病变发生率方面尚无差异或增高。在缩短热程上两者差异也不显著。尚可进一步通过更大数量病例的随机对照研究来证实本结果。目前治疗川崎病不主张单独应用激素。

Objective

To investigate the efficacy of corticosteroids in Kawasaki disease throughcomparing it with intravenous immunoglobulin.

Methods

We included all randomized or quasi-randomized control trials related by searching the Controlled Trials Register, Medline, EMBASE, two databases in Japan, and CNKI (Chinese National Knowledge Infrastructure, Jan1994-Jan 2003), checking the reference lists of articles, and contacting the experts in this field. Data collection and meta-analysis were done to evaluate the effect of corticosteroids.

Results

Eight trials were included (n = 913). Because of the methodological differences, the results were not pooled. Methodologically, the quality of the included studies was not high. Considering the occurrence of coronary aneurysms, three studies about methylprednisolone showed no significant difference between those receiving methylprednisolone and IVIG or aspirin (RR 0. 71 ~1. 33, 95%CI 0. 22 ~4. 97), four studies about prednisone showed increased morbidity compared with the IVIG or aspirin group (RR 1. 50~7. 00, 95%CI 0. 64~55. 87) and one has no data. In respect of the occurrence of coronary dilation, five trials showed an tendency of increased morbidity of coronary dilation in patients receiving steroid (RR 1. 24~9. 00, 95%CI 0. 64~69. 74) while one (Yuan; 2000) showed no difference and two showed slightly reduced occurrence of coronary dilation compared with the control group (RR 0. 80~0. 89, 95%CI 0. 19~3. 37). One of the studies seemed to have low stringency because of the inadequacy of cases (Nakamura; 1985). For the course of febrile, one study showed significantly shortened course in those receiving methylprednisolone and aspirin compared with the control group (Hashino ; 2001), two studies showed slight reduce of course in those receiving methylprednisolone and IVIG or aspirin (Yuan; 2000, Seto; 1983). There were no data of febrile course among those receiving prednisone.

Conclusions

The selection of steroid therapy for Kwasaki disease should be more prudent in spite of its possible benefit in shortening the febrile duration, considering its intendancy in increasing the morbidity of coronary aneurysms and dilation.

图1 甲基强的松龙与IVIG组冠状动脉扩张发生率的Meta分析
图2 甲基强的松龙与IVIG组冠状动脉瘤发生率的Meta分析
图3 甲基强的松龙与IVIG组发热天数的Meta分析
图4 强的松与阿司匹林组冠状动脉瘤发生率的Meta分析
图5 强的松与阿司匹林组冠状动脉扩张发生率的Meta分析
1 Kawasaki T. Acute febrile mucocutaneous syndrome with lymphoid involvement with specific desquamation of the fingers and toes in children. Arerugi, 1967,16(3) :178-222.
2 Taubert KA, Rowley AH, Shulman ST. Nationwide survey ofKawasaki disease and acute rheumatic fever. J Pediatr,1991,119(2):279-282.
3 Yanagawa H, Yashiro M, Nakamura Y, et al. Results of 12nationwide epidemiological incidence surveys of Kawasaki disease in Japan. Arch Pediatr Adolesc Med, 1995,149(7) :779-783.
4 Bronstein DE,Besser RE,Burns JC. Passive surveillance forKawasaki disease in San Diego County. Pediatr Infect Dis J ,1997,16(11):1015-1018.
5 Furusho K,Kamiya T,Nakano H,et al. High-dose intravenousgammaglobulin for Kawasaki disease. Lancet, 1984,2 (8411):1055-1058.
6 Kato H, Koike S,Yokoyama T. Kawasaki disease :effect oftreatment on coronary artery involvement. Pediatrics, 1979,63(2):175-179.
7 Kato H,Ichinose E. Therapy of Kawasaki disease in the acutephase:steroid and aspirin therapy. Jpn Pediatr,1983,41(9):2092-2096.
8 Jadad AR,Cook DJ,Jones A,et al. Methodology and reports of systematic reviews and meta-analyses :a comparison of Cochrane reviews with articles published in paper-based journals. JAMA,1998,15(280):278-280.
9 Egger M, Smith GD, Phillips AN. Meta-analysis :principles and procedures. BMJ, 1997,315(7121) :1533-1537.
10 Kanoko H,Masahiro I,Motofumi I,et al. Re-treatment for immune-globulin resistant Kawasaki disease :a comparative study of additional immune globulin and steroid pulse therapy. Pediatr Int, 2001, 43(3):211-217.
11 袁渝,李桂玲,孟姜华等.皮质激素治疗川崎病25例近期疗效分析.中国实用儿科杂志,2000,15(1):49.
12 Toshio A, Katsunori T, Sanji K, et al. Follow-up data of prospective controlled study for the treatment,clinical sign and laboratory data of Kawasaki disease. Pediatrics J, 1986,90(8):1844-1849.
13 Sanji K, Katsunori T. A prospective study for treatment ofKawasaki disease with 3 regimens :aspirin,flubiprofen,predonisolone + dipyridamole. J Jpn Pediatr Soc, 1983,87(12):2486-2491.
14 Sanji K, Katsunori T. Studies on treatment of Kawasaki disease during acute stage. J Jpn Pediatr Soc, 1985,89(4):814-818.
15 Sanji K, Katsunori T. A randomized controlled study of three different therapies for patients having Kawasaki disease. J Jpn Pediatr Soc,1986,90(8) :1844-1849.
16 Shiro S, Takeshi M, Takao H, et al. Acontrolled trial of steroid pulse therapy for Kawasaki disease :part 1. J Jpn Pediatr Soc,1983,87(3):399-406.
17 Toshio N. Studies on activated platelets in Kawasaki disease. J Jpn Pediatr Soc, 1985,89(8) :1845-1860.
18 Nonaka Y, Usui N, Eto Y, et al. Are patients with Kawasaki disease not respond IVGG therapy treated with super large amount of gamma-globulin? Prog Med, 2000, 20(7) :1430-1434.
19 Kijima Y,Kamiya T, Suzuki A, et al. A trial procedure to prevent aneurysm formation of the coronary arteries by steroid pulse therapy in Kawasaki disease. Jpn Circ J,1982,46(11):1239-1242.
20 Kijima Y. Effect of methylprednisolone administrations for patients with Kawasaki disease to prevent coronary aneurysm formation in the acute stage. J Osaka Med College, 1983,42(3-4):313-320.
21 Shiro S, Kuniaki O, Takeshi M, et al. A controlled trial of steroid pulse therapy for Kawasaki disease :part 2. J Jpn Pediatr Soc, 1984, 88(6):1234-1240.
22 Kamiya T. Progress in treatment for Kawasaki disease. Recent Adv Cardiovasc Dis, 1989,10(2) :170-176.
23 Dahlem PG, von Rosenstiel IA, Lam J, et al. Pulse methylprednisolone therapy for impending cardiac tamponade in immunoglobulin-resistant Kawasaki disease. Intensive Care Med,1999,25(10):1137-1139.
24 Dale RC,Saleem MA, Daw S,et al. Treatment of severe complicated Kawasaki disease with oral prednisolone and aspirin. J Pediatr, 2000,137(5):723-726.
25 Kelly PC, Pearl WR,Weir MR. Infantile polyarteritis nodosa with mucocutaneous lymph node syndrome treated with long-term corticosteroids. South Med J, 1987,80(8) :1045-1048.
26 Newburger JW. Treatment of Kawasaki disease :corticosteroids revisited. J Pediatr,1999,135(4) :411-413.
27 Shulman ST, Rowley AH. Treatment of Kawasaki disease with corticosteroid. J Pediatr, 1996,128(1):146-149.
28 Shinohara M, Sone K, Kobayashi T, et al. Treatment ofKawasaki disease with corticosteroid. J Pediatr, 1996,129(3):483-484.
29 Han RK, Silverman ED, Newman A, et al. Management and outcome of persistent or recurrent fever after initial intravenous gamma globulin therapy in acute Kawasaki disease. Arch Pediatr Adolesc Med, 2000 Jul, 154(7) :694-699.
30 Wallace CA, French JW, Kahn SJ, et al. Initial intravenous gammaglobulin treatment failure in Kawasaki disease. Pediatr,2000,105(6):E78.
31 Raman V,Kim J, Sharkey A, et al. Response of refractory Kawasaki disease to pulse steroid and cyclosporin A therapy. Pediatr Infect Dis J,2001,20(6) : 635-637.
32 Wright DA, Newburger JW,Baker A, et al. Treatment of immune globulin-resistant Kawasaki disease with pulsed doses of corticosteroids. J Pediatr, 1996,128(1) :146-149.
33 Makota S, Katsuhiko S,Takeshi T, et al. Corticosteroids in thetreatment of the acute phase of Kawasaki disease. J Pediatr,1999,135:465-469.
[1] 杨皓媛, 龚杰, 邹青伟, 阮航. 哮喘孕妇的母婴不良妊娠结局研究现状[J]. 中华妇幼临床医学杂志(电子版), 2023, 19(05): 522-529.
[2] 张玉凤, 徐鹏飞, 唐甜甜, 刘瑞清, 万涵. 儿童川崎病并发胆汁淤积和无菌性脑膜炎一例[J]. 中华实验和临床感染病杂志(电子版), 2023, 17(01): 60-64.
[3] 龚茂迪, 李涛, 陈伟, 徐述雄. 一例长期口服糖皮质激素患者在经皮肾镜碎石取石术后反复发热的管理经验[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(03): 284-287.
[4] 柴雅琴, 金发光, 郭晓雅, 张红军, 王瑞璇, 路玲, 顾兴. 特发性高嗜酸性粒细胞增多综合征伴多脏器受损一例病例报道[J]. 中华肺部疾病杂志(电子版), 2023, 16(03): 448-450.
[5] 肖田恬, 丁桃容, 刘婷婷. 异丙托溴铵联合糖皮质激素治疗COPD的临床分析[J]. 中华肺部疾病杂志(电子版), 2022, 15(06): 885-887.
[6] 严瑾, 王继鹏. 肺泡气一氧化氮对咳嗽变异性哮喘ICS+LABA治疗反应的意义[J]. 中华肺部疾病杂志(电子版), 2022, 15(05): 673-675.
[7] 刘骞. 直肠癌侧方淋巴结清扫中国临床开展的现状[J]. 中华结直肠疾病电子杂志, 2022, 11(05): 367-371.
[8] 郑颖, 孟金铃, 蔡广研, 冯哲. 混合式教学模式在肾脏病学专业学位研究生循证医学课程中的实践与思考[J]. 中华肾病研究电子杂志, 2023, 12(01): 48-50.
[9] 李子扬, 包继文, 尧欢珍, 张敏芳, 顾乐怡, 倪兆慧, 王玲. 低剂量免疫抑制剂治疗轻中症ANCA相关性肾血管炎的效果和肾脏预后分析[J]. 中华肾病研究电子杂志, 2022, 11(05): 241-248.
[10] 吴宗盛, 谢剑锋, 邱海波. 2021版拯救脓毒症运动指南:早期复苏的八大“陷阱”[J]. 中华重症医学电子杂志, 2023, 09(01): 14-18.
[11] 王欣, 刘琳, 闻哲嘉, 刘春玲, 张弘, 吕芳. 妊娠前应激暴露对小鼠后续妊娠的影响[J]. 中华临床医师杂志(电子版), 2023, 17(04): 431-437.
[12] 孙飞, 罗军, 向金波, 胡小燕. 川崎病病原菌感染及易感基因多态性的研究现状[J]. 中华临床医师杂志(电子版), 2023, 17(01): 89-92.
[13] 严楠, 杜丽雪, 依斯坎德尔·依沙江, 宋美娜, 王非, 王仲. 医疗决策中的循证与叙事依据[J]. 中华临床医师杂志(电子版), 2022, 16(11): 1142-1145.
[14] 张娟, 纪青, 胡国宏, 谭成, 王双双, 易秀英. CD11b基因rs4597342位点多态性与川崎病的相关性研究[J]. 中华诊断学电子杂志, 2023, 11(02): 92-96.
[15] 王晓玲, 杨婷, 尹专叶, 张颖. 脑卒中后抑郁状态识别与预防的最佳证据总结[J]. 中华脑血管病杂志(电子版), 2023, 17(01): 51-56.
阅读次数
全文


摘要