针对MIS-C的免疫调节疗法
Naïm Ouldali1,2,3, Mary Beth F Son4,5, Andrew J McArdle6
1Division of Infectious diseases, Department of Pediatric Infectious Diseases, Sainte Justine University Hospital, University of Montreal, Quebec, Canada.
Pediatrics
|June 28, 2023
概括
与IVIG单独相比,静脉注射免疫球蛋白 (IVIG) 和葡萄糖皮质激素的组合改善了多系统炎症综合征 (MIS-C) 的儿童的心血管功能障碍. 单独使用葡萄糖皮质类药物并没有显示出改善的结果.
科学领域:
- 儿科重症监护医药 儿科重症监护医药
- 免疫学 免疫学 免疫学
- 传染病 传染病 传染病
背景情况:
- 儿童多系统炎症综合征 (MIS-C) 治疗策略有相互矛盾的证据.
- 对MIS-C的最佳初始治疗仍然是积极研究的领域.
研究的目的:
- 为了比较静脉注射免疫球蛋白 (IVIG),葡萄糖皮质类药物或它们的组合作为MIS-C的初始治疗的有效性.
- 评估不同治疗方案对MIS-C患者心血管功能障碍的影响.
主要方法:
- 随机和观察性比较研究的系统审查和元分析.
- 在2020年1月至2022年2月期间搜索了Medline,Embase,CENTRAL和WOS.
- 包括21岁以下的MIS-C患者;使用倾向性得分匹配分析分析了心血管功能障碍.
主要成果:
- 对来自3个非随机队列的958名儿童的分析显示,IVIG加上葡萄皮质类药物改善了心血管功能障碍 (CD),与单独使用IVIG相比 (OR 0.62).
- 单独使用葡萄皮质固醇与单独使用IVIG (OR 0.57) 或IVIG加葡萄皮质固醇 (OR 0.67) 相比,并没有改善CD.
- 二次分析表明,IVIG加上葡萄皮糖类药物对发烧持续时间和二次治疗的需要有好处.
结论:
- 与IVIG单独治疗相比,IVIG和葡萄糖皮质激素的组合证明了MIS-C患者心血管结果的改善.
- 作为MIS-C的唯一初始治疗方法的葡萄糖皮质类药物没有显示出优越的心血管益处.
- 包含的研究的非随机性质是一个关键的限制.
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