Beck Carolyn E, Nathan Paul C, Parkin Patricia C, Blanchette Victor S, Macarthur Colin
Division of Paediatric Medicine, The Hospital for Sick Children, and the University of Toronto, Toronto, Ontario, Canada.
J Pediatr. 2005 Oct;147(4):521-7. doi: 10.1016/j.jpeds.2005.04.032.
To compare the effectiveness of corticosteroids with intravenous immune globulin (IVIG) for the initial treatment of children with acute immune thrombocytopenic purpura (ITP).
A systematic review and meta-analysis of randomized controlled trials comparing corticosteroids with IVIG. Studies were identified from eight electronic databases, meeting abstracts, expert consultation, and hand-searched reference lists. Two authors independently reviewed potentially eligible studies and extracted data. The number of patients with a platelet count >20,000/mm3, 48 hours after treatment initiation, was the primary outcome. Relative risks (RR) and risk differences were pooled using a random effects model, and numbers needed to treat (NNT) were calculated.
A total of 1248 abstracts were reviewed, 55 articles were retrieved, and 10 studies were included. The RR (steroids vs IVIG) of achieving a platelet count >20,000/mm3 at 48 hours was 0.74 (95% CI: 0.65, 0.85), and the NNT was 4.55 (95% CI: 3.23, 7.69).
Children treated with corticosteroids for acute ITP are 26% less likely to have a platelet count >20,000/mm3 after 48 hours of therapy, when compared with children treated with IVIG. Given the importance of low platelets in the pathogenesis of intracranial hemorrhage (ICH), this difference may hold important clinical implications.
比较皮质类固醇与静脉注射免疫球蛋白（IVIG）对儿童急性免疫性血小板减少性紫癜（ITP）初始治疗的有效性。
对比较皮质类固醇与IVIG的随机对照试验进行系统评价和荟萃分析。从八个电子数据库、会议摘要、专家咨询和手工检索的参考文献列表中识别研究。两位作者独立审查潜在符合条件的研究并提取数据。治疗开始后48小时血小板计数>20,000/mm3的患者数量为主要结局。使用随机效应模型汇总相对风险（RR）和风险差异，并计算治疗所需人数（NNT）。
共审查了1248篇摘要，检索到55篇文章，纳入10项研究。48小时时血小板计数>20,000/mm3的RR（类固醇与IVIG）为0.74（95%CI：0.65，0.85），NNT为4.55（95%CI：3.23，7.69）。
与接受IVIG治疗的儿童相比，接受皮质类固醇治疗急性ITP的儿童在治疗48小时后血小板计数>20,000/mm3的可能性低26%。鉴于血小板减少在颅内出血（ICH）发病机制中的重要性，这种差异可能具有重要的临床意义。
