摘要
目的分析糖皮质激素与静脉注射用人免疫球蛋白（IVIG）治疗儿童急性原发性免疫性血小板减少症（ITP）的有效性及安全性。方法计算机检索Pub Med、the Cochrane Database of Systematic Reviews、the Cochrane Central Register of Controlled Trials、中国生物医学文献数据库（CBM）、中国期刊全文数据库（CNKI）、万方数据库,手工查阅计算机检索到的文献的参考文献目录,按照纳入与排除标准筛选文献,提取数据和评价纳入文献的质量,采用Revman 5.3软件进行meta分析。结果共检索到相关文献1 500篇,有8篇文献符合纳入标准。meta分析显示,治疗48 h后,糖皮质激素组与IVIG组血小板计数（PLT）〉20×10^9/L的差异有统计学意义（RR=0.77,95%CI：0.67～0.89）;亚组分析,甲基泼尼松龙（MP）30 mg/kg与IVIG 1 g/（kg·d）×2 d比较,泼尼松（PDN）4 mg/kg与IVIG 1 g/（kg·d）×2 d比较,差异均有统计学意义（RR=0.66,95%CI：0.47～0.91;RR=0.79,95%CI：0.66～0.95）。治疗24、72 h后,糖皮质激素组与IVIG组血小板计数〉20×10^9/L比较,差异有统计学意义（RR=0.69,95%CI：0.53～0.91;RR=0.82,95%CI：0.74～0.90）。治疗24、48、72 h后糖皮质激素组与IVIG组血小板计数〉50×10^9/L比较,差异有统计学意义（RR=0.38,95%CI：0.21～0.69;RR=0.53,95%CI：0.41～0.69;RR=0.80,95%CI：0.70～0.93）。糖皮质激素组与IVIG组脾切除发生率的差异无统计学意义（RR=5.41,95%CI：0.95～30.74,P=0.06）。结论接受糖皮质激素治疗的急性ITP患儿在初始治疗48 h达到血小板计数〉20×10^9/L的概率较接受IVIG患儿低23%;以在前3天内将血小板计数提升到〉50×10^9/L为初始治疗目标,IVIG的效果更好。
Objective To compare the effectiveness and safety of glucocorticoid versus intravenous injection of human immunoglobulin（IVIG） in treatment of with acute primary immune thrombocytopenia（ITP） in children. Methods Pub Med, the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, Chinese biomedical literature database（CBM）, Chinese Journal Full Text Database（CNKI） and Wanfang database were searched. The bibliography was screened according to the inclusion and exclusion criteria,and the target literatures were selected. The data were extracted and the quality of included literatures was evaluated. Revman 5. 3 software was used to make meta-analysis. Results In 1500 papers searched, 8 papers met the inclusion criteria. Meta-analysis showed that there was a statistical significance in platelet count（PLT, 20×10^9/L） after being treated for 48 h between glucocorticoid group and IVIG group（RR = 0. 77, 95 % CI： 0. 67 ～ 0. 89）. In subgroup analysis, there were statistical significance in methylprednisolone（MP） 30 mg/kg versus IVIG 1 g/（kg·d）×2 d, and metacortandratin（PDN） 4 mg/kg versus IVIG 1 g/（kg·d）× 2 d（RR = 0. 66, 95 % CI： 0. 47- 0. 91; RR= 0. 79, 95 % CI： 0. 66-0. 95）. After treatment for 24 h and 72 h, the platelet count 20 × 10^9/L were significantly different in glucocorticoid group and in IVIG group（RR = 0. 69, 95 % CI： 0. 53- 0. 91; RR= 0. 82, 95 % CI： 0. 74- 0. 90）. Moreover, after treatment for 24 h, 48 h and 72 h, the platelet count 50 × 10^9/L were significantly different between glucocorticoid group and IVIG group（RR=0.38,95 % CI： 0. 21- 0. 69; RR = 0. 53, 95 % CI： 0. 41- 0. 69; RR = 0. 80, 95 % CI： 0. 70- 0. 93）. There was no difference in the incidence of splenic resection between two groups（RR = 5. 41, 95 % CI： 0. 95- 30. 74, P = 0. 06）. Conclusion The probability of platelet count to reach 20 × 10^9/L in the initial treatment with glucocorticoid of acute ITP patients were 32 % lower than that with IVIG. With the initial therapeutic target being platelet count 50 × 10^9/L in 3 days, the effect of IVIG was better.
出处
《临床儿科杂志》
CAS
CSCD
北大核心
2016年第9期694-702,共9页
Journal of Clinical Pediatrics
基金
四川省教育厅重点科研基金(No.川教函[2011]004号)
