Chinese Medical E-ournals Database

Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition) ›› 2005, Vol. 01 ›› Issue (02): 87 -92. doi: 10.3877/cma.j.issn.1673-5250.2005.02.106

Original Article

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
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
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