静脉注射免疫球蛋白治疗抗中性粒细胞胞浆抗体相关性血管炎的疗效：一项荟萃分析。
The therapeutic efficacy of intravenous immunoglobulin in anti-neutrophilic cytoplasmic antibody-associated vasculitis: a meta-analysis.
机构信息
Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine.
Laboratory of Immunopathology, World Premier International Immunology Frontier Research Center, Suita, Osaka, Japan.
出版信息
Rheumatology (Oxford). 2020 May 1;59(5):959-967. doi: 10.1093/rheumatology/kez311.
OBJECTIVES
The therapeutic effects of IVIG in patients with ANCA-associated vasculitis (AAV) have not been established so far. This study aims to estimate the effects of IVIG on AAV by conducting a systematic review and meta-analysis.
METHODS
A comprehensive systematic review was conducted in accordance with the guidelines of PRISMA (Preferred Reporting Items for Systematic Reviews And Meta-analyses). PubMed and Google Scholar were used to search for original studies on AAV and collect clinical data before and after IVIG treatment. A meta-analysis of each clinical parameter was performed, and standardized mean difference (SMD) and 95% CI were calculated using the random effects model.
RESULTS
A total of 220 studies were identified, and nine met the selection criteria for the meta-analysis. IVIG was administered to active AAV patients as an immunomodulatory therapy in the nine studies selected. Significant reductions in BVAS (SMD -1.7; 95% CI [-2.66, -0.73]; P = 0.0006), ANCA (SMD -0.72; 95% CI [-1.13, -0.31]; P = 0.0006) and CRP (SMD -0.92; 95% CI [-1.49, -0.35]; P = 0.002) were noted within 6 months after administration of IVIG. Subgroup analysis in the unmodified immunotherapy population showed reductions in BVAS (SMD -1.39; 95% CI [-2.31, -0.48]; P = 0.003) and CRP (SMD -0.56; 95% CI [-0.93, -0.19]; P = 0.002) within half a month after IVIG treatment.
CONCLUSION
IVIG was associated with rapid improvements in disease activity and the related biomarkers in patients with active AAV.
目的
目前尚未确定静脉注射免疫球蛋白（IVIG）治疗抗中性粒细胞胞质抗体（ANCA）相关性血管炎（AAV）的疗效。本研究旨在通过系统评价和荟萃分析来评估 IVIG 对 AAV 的影响。
方法
根据 PRISMA（系统评价和荟萃分析的首选报告项目）指南进行全面的系统评价。使用 PubMed 和 Google Scholar 搜索 AAV 的原始研究，并收集 IVIG 治疗前后的临床数据。对每个临床参数进行荟萃分析，并使用随机效应模型计算标准化均数差（SMD）和 95%置信区间（CI）。
结果
共确定了 220 项研究，其中 9 项符合荟萃分析的选择标准。在选定的 9 项研究中，IVIG 被用作治疗活动期 AAV 患者的免疫调节治疗。在接受 IVIG 治疗后 6 个月内，BVAS（SMD-1.7；95%CI[-2.66，-0.73]；P=0.0006）、ANCA（SMD-0.72；95%CI[-1.13，-0.31]；P=0.0006）和 CRP（SMD-0.92；95%CI[-1.49，-0.35]；P=0.002）显著降低。在未修正的免疫治疗人群中进行的亚组分析显示，BVAS（SMD-1.39；95%CI[-2.31，-0.48]；P=0.003）和 CRP（SMD-0.56；95%CI[-0.93，-0.19]；P=0.002）在接受 IVIG 治疗后半个月内降低。
结论
IVIG 与活动期 AAV 患者的疾病活动度和相关生物标志物的快速改善相关。
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