静脉注射免疫球蛋白治疗暴发性心肌炎对院内死亡率的影响：倾向评分分析。
Effect of intravenous immunoglobulin for fulminant myocarditis on in-hospital mortality: propensity score analyses.
机构信息
Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan; Department of Cardiology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.
Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
出版信息
J Card Fail. 2015 May;21(5):391-397. doi: 10.1016/j.cardfail.2015.01.004. Epub 2015 Jan 30.
BACKGROUND
Fulminant myocarditis (FM) is a rare but life-threatening disease. Intravenous immunoglobulin (IVIG) is not recommended for acute or chronic myocarditis in Western nations owing to the lack of rigorous evidence, but it is widely used in other countries, including Japan. This nationwide retrospective cohort study focused on evaluating the effect of IVIG in FM patients.
METHODS AND RESULTS
Using the Diagnosis Procedure Combination database in Japan, we identified 603 FM patients aged ≥16 years who received mechanical circulatory support within 7 days after admission. We performed propensity score analyses to compare the in-hospital mortality and total costs between IVIG users (n = 220; 36.5%) and nonusers (n = 383; 63.5%). Among propensity score-matched patients (164 pairs), there was no significant difference in in-hospital mortality between IVIG users and nonusers (36.6% vs 37.2%; P = .909). A multivariable logistic regression analysis showed no significant association between IVIG use and in-hospital mortality (adjusted odds ratio 0.91; 95% confidence interval 0.52 to 1.58; P = .733). The median total costs were significantly higher for IVIG users than for nonusers (US $44,226 vs $33,280; P < .001).
CONCLUSION
IVIG for FM was not significantly associated with a decrease in in-hospital mortality.
背景
暴发性心肌炎（FM）是一种罕见但危及生命的疾病。由于缺乏严格的证据，西方国家不推荐在急性或慢性心肌炎中使用静脉注射免疫球蛋白（IVIG），但在包括日本在内的其他国家，IVIG 被广泛使用。这项全国性回顾性队列研究侧重于评估 IVIG 在 FM 患者中的疗效。
方法和结果
我们使用日本的诊断程序组合数据库，确定了 603 名年龄≥16 岁且在入院后 7 天内接受机械循环支持的 FM 患者。我们进行了倾向评分分析，以比较 IVIG 使用者（n=220；36.5%）和非使用者（n=383；63.5%）的住院死亡率和总费用。在倾向评分匹配的患者（164 对）中，IVIG 使用者和非使用者的住院死亡率无显著差异（36.6%比 37.2%；P=0.909）。多变量逻辑回归分析显示，IVIG 使用与住院死亡率之间无显著关联（调整比值比 0.91；95%置信区间 0.52 至 1.58；P=0.733）。IVIG 使用者的总费用中位数明显高于非使用者（44226 美元比 33280 美元；P<0.001）。
结论
IVIG 治疗 FM 与降低住院死亡率无显著相关性。
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