Department of Pediatrics, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan, Republic of China.
Division of Infectious Diseases, Department of Pediatrics, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan, Republic of China.
Sci Rep. 2019 Jul 18;9(1):10459. doi: 10.1038/s41598-019-46888-0.
The treatment of pediatric myocarditis is controversial, and the benefits of intravenous immunoglobulin (IVIG) are inconclusive due to limited data. We searched studies from PubMed, MEDLINE, Embase, and Cochrane Library databases since establishment until October 1st, 2018. Thirteen studies met the inclusion criteria. We included a total of 812 patients with IVIG treatment and 592 patients without IVIG treatment. The meta-analysis showed that the survival rate in the IVIG group was higher than that in the non-IVIG group (odds ratio = 2.133, 95% confidence interval (CI): 1.32-3.43, p = 0.002). There was moderate statistical heterogeneity among the included studies (I = 35%, p = 0.102). However, after adjustment using Duval and Tweedie's trim and fill method, the point estimate of the overall effect size was 1.40 (95% CI 0.83, 2.35), which became insignificant. Moreover, the meta-regression revealed that age (coefficient = -0.191, 95% CI (-0.398, 0.015), p = 0.069) and gender (coefficient = 0.347, 95% CI (-7.586, 8.279), p = 0.93) were not significantly related to the survival rate. This meta-analysis showed that IVIG treatment was not associated with better survival. The use of IVIG therapy in acute myocarditis in children cannot be routinely recommended based on current evidence. Further prospective and randomized controlled studies are needed to elucidate the effects of IVIG treatment.
小儿心肌炎的治疗存在争议，由于数据有限，静脉注射免疫球蛋白（IVIG）的疗效尚无定论。我们检索了从建库至 2018 年 10 月 1 日PubMed、MEDLINE、Embase 和 Cochrane Library 数据库中的研究。符合纳入标准的研究共有 13 项。我们共纳入 812 例接受 IVIG 治疗的患者和 592 例未接受 IVIG 治疗的患者。Meta 分析显示，IVIG 组的生存率高于非 IVIG 组（比值比=2.133，95%置信区间（CI）：1.32-3.43，p=0.002）。纳入研究存在中等程度的统计学异质性（I=35%，p=0.102）。然而，采用 Duval 和 Tweedie 的修剪和填充方法进行调整后，总体效应量的点估计值为 1.40（95%CI 0.83，2.35），不再具有统计学意义。此外，Meta 回归显示年龄（系数=-0.191，95%CI（-0.398，0.015），p=0.069）和性别（系数=0.347，95%CI（-7.586，8.279），p=0.93）与生存率无显著相关性。本 Meta 分析显示，IVIG 治疗与生存率的提高无关。基于目前的证据，不能常规推荐在儿童急性心肌炎中使用 IVIG 治疗。需要进一步开展前瞻性和随机对照研究来阐明 IVIG 治疗的效果。
