Department of Gastroenterology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou.
Department of Pediatrics, Jinhua Hospital, Zhejiang University and Jinhua Municipal Central Hospital, Jinhua, Zhejiang, People's Republic of China.
Rheumatology (Oxford). 2020 Aug 1;59(8):1826-1833. doi: 10.1093/rheumatology/keaa050.
The use of IVIG plus high- or low-dose aspirin for the initial treatment of Kawasaki disease remains controversial. The aim of this study was to evaluate the efficacy of IVIG plus high-dose aspirin compared with IVIG plus low-dose aspirin in the treatment of Kawasaki disease.
Studies related to aspirin therapy for Kawasaki disease were selected by searching the databases of Medline (PubMed), Embase and the Cochrane Library before March 2019. Statistical analyses were performed by using a Review Manager Software package and STATA v.15.1.
Eight retrospective cohort studies, characterizing 12 176 patients, were analysed. Overall, no significant difference was found in the incidence of coronary artery abnormalities between the high- and low-dose aspirin groups [relative risk (RR) 1.15; 95% CI: 0.93, 1.43; P = 0.19; random-effects model]. The patients treated with high-dose aspirin had slightly faster resolution of fever [mean difference (MD) -0.30; 95% CI: -0.58, -0.02; P = 0.04; random-effects model]. but the rates of IVIG resistance (RR, 1.26; 95% CI: 0.55, 2.92; P = 0.59; random-effects model) and days in hospital (MD, 0.22; 95% CI: -0.93, 1.37; P = 0.71; random-effects model) were similar between the two groups.
Low-dose aspirin plus IVIG might be as effective as high-dose aspirin plus IVIG for the initial treatment of Kawasaki disease. Considering that high-dose aspirin may cause more adverse reactions than low-dose aspirin, low-dose aspirin plus IVIG should be recommended as the first-line therapy in the initial treatment of Kawasaki disease.
静脉注射免疫球蛋白（IVIG）联合高或低剂量阿司匹林用于川崎病初始治疗仍存在争议。本研究旨在评估 IVIG 联合高剂量阿司匹林与 IVIG 联合低剂量阿司匹林治疗川崎病的疗效。
通过检索 Medline（PubMed）、Embase 和 Cochrane 图书馆数据库，筛选出与阿司匹林治疗川崎病相关的研究，检索时间截至 2019 年 3 月。采用 Review Manager 软件和 STATA v.15.1 进行统计学分析。
共纳入 8 项回顾性队列研究，包含 12176 例患者。总体而言，高剂量和低剂量阿司匹林组的冠状动脉异常发生率无显著差异[相对危险度（RR）1.15；95%可信区间：0.93，1.43；P = 0.19；随机效应模型]。高剂量阿司匹林组患者的发热缓解速度略快[平均差（MD）-0.30；95%可信区间：-0.58，-0.02；P = 0.04；随机效应模型]，但 IVIG 抵抗率（RR，1.26；95%可信区间：0.55，2.92；P = 0.59；随机效应模型）和住院天数（MD，0.22；95%可信区间：-0.93，1.37；P = 0.71；随机效应模型）相似。
低剂量阿司匹林联合 IVIG 可能与高剂量阿司匹林联合 IVIG 同样有效用于川崎病的初始治疗。鉴于高剂量阿司匹林比低剂量阿司匹林可能引起更多不良反应，低剂量阿司匹林联合 IVIG 应作为川崎病初始治疗的一线治疗方案。
