National Center for Child Health and Development, School of Public Health, University of Tokyo, Tokyo, Japan, and Fielding School of Public Health, University of California, Los Angeles.
School of Public Health, University of Tokyo, Tokyo, Japan.
Arthritis Care Res (Hoboken). 2018 Jul;70(7):1052-1057. doi: 10.1002/acr.23456. Epub 2018 May 22.
Several studies revealed the efficacy of glucocorticoids on prevention of coronary artery lesions (CALs) in Kawasaki disease (KD) patients. However, impacts of different doses of glucocorticoids on clinical outcomes of KD remain unknown.
Using the Japanese Diagnosis Procedure Combination inpatient database, we evaluated KD patients who were treated with normal-dose (prednisolone 0.5-4.0 mg/kg/day) or high-dose (methylprednisolone 10-40 mg/kg/day) glucocorticoids. We investigated risks of CALs and readmission, total hospitalization cost, and length of hospital stay in the acute phase of KD using propensity score matching, stabilized propensity-score inverse probability of treatment weighting, and instrumental variable methods.
We identified a total of 3,220 patients with KD who were treated with normal-dose (n = 2,453) or high-dose (n = 767) glucocorticoids in addition to intravenous immunoglobulin. One-to-one propensity-matched analyses with 744 pairs demonstrated no significant differences between the normal-dose and the high-dose groups in risk of CALs (risk ratio [RR] 0.83, 95% confidence interval [95% CI] 0.49, 1.40) and risk of readmissions (RR 0.85, 95% CI 0.65, 1.11). Stabilized propensity-score inverse probability weighting and instrumental variable analyses showed similar results to the propensity score matching analyses.
Risks of CALs and readmissions and total hospitalization costs were similar between the normal-dose and the high-dose glucocorticoids groups for patients with KD, whereas total length of hospital stay was shorter in the high-dose group than that in the normal-dose group.
多项研究表明糖皮质激素可有效预防川崎病（KD）患者冠状动脉病变（CALs）。然而，不同剂量糖皮质激素对 KD 临床结局的影响尚不清楚。
利用日本诊断程序组合住院数据库，我们评估了接受常规剂量（泼尼松龙 0.5-4.0mg/kg/日）或高剂量（甲泼尼龙 10-40mg/kg/日）糖皮质激素治疗的 KD 患者。我们采用倾向评分匹配、稳定倾向评分逆概率治疗加权和工具变量方法，调查了 CALs 和再入院、总住院费用和 KD 急性期住院时间的风险。
我们共纳入 3220 例接受静脉注射免疫球蛋白联合常规剂量（n=2453）或高剂量（n=767）糖皮质激素治疗的 KD 患者。1:1 倾向评分匹配后，共 744 对患者中，CALs 风险（风险比 [RR]0.83，95%置信区间 [95%CI]0.49，1.40）和再入院风险（RR0.85，95%CI0.65，1.11）在常规剂量组和高剂量组之间无显著差异。稳定倾向评分逆概率治疗加权和工具变量分析结果与倾向评分匹配分析相似。
对于 KD 患者，常规剂量和高剂量糖皮质激素组的 CALs 和再入院风险及总住院费用相似，而高剂量组的总住院时间短于常规剂量组。
