Huang Ying-Hua, Hsin Yi-Chen, Wang Liang-Jen, Feng Wei-Ling, Guo Mindy Ming-Huey, Chang Ling-Sai, Tu Yu-Kang, Kuo Ho-Chang
Department of Pediatrics and Kawasaki Disease Center, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Department of Pediatric Allergy, Immunology, and Rheumatology, Division of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
Front Pharmacol. 2021 Aug 12;12:725126. doi: 10.3389/fphar.2021.725126. eCollection 2021.
Aspirin was once believed to reduce the mortality of Kawasaki disease (KD) due to its effect on the thrombotic occlusion of coronary arteries. However, conflicting evidence has been found regarding aspirin treatment and its benefit in patients with acute KD. We compared the efficacy of different aspirin doses in acute KD. A literature search of PubMed, EMBASE, and Cochrane databases was conducted to identify studies comparing different doses of aspirin for acute KD. The primary outcome of interest was coronary artery lesions (CAL). We used random-effects network meta-analysis. Six retrospective studies, including 1944 patients receiving aspirin in doses of 0, 3-5, 30-50, or 80-100 mg/kg/day, were selected. The risks of CAL were not significantly different for the various doses of aspirin compared to the placebo: odds ratio (OR) was 1.10 [95% confidence interval (CI): 0.70-1.71] for patients with aspirin 3-5 mg/kg/day; OR = 1.23 (95% CI: 0.67-2.26) for aspirin 30-50 mg/kg/day, and OR = 1.59 (95% CI: 0.74, 3.421) for 80-100 mg/kg/day. The P-score ranged from 0.76 for placebo to 0.19 for aspirin 80-100 mg/kg/day. The different doses of aspirin exhibited no significant difference with regard to the efficacy of CAL or with the secondary outcomes of intravenous immunoglobulin resistance or hospital stays for acute KD. Therefore, we found that treatment without any aspirin is not inferior to other doses of aspirin and can also slightly reduce the risk of CAL.
阿司匹林曾被认为可降低川崎病（KD）的死亡率，因其对冠状动脉血栓闭塞有作用。然而，关于阿司匹林治疗及其对急性KD患者的益处，已发现相互矛盾的证据。我们比较了不同剂量阿司匹林在急性KD中的疗效。对PubMed、EMBASE和Cochrane数据库进行文献检索，以确定比较不同剂量阿司匹林治疗急性KD的研究。感兴趣的主要结局是冠状动脉病变（CAL）。我们使用随机效应网络荟萃分析。选择了6项回顾性研究，包括1944例接受剂量为0、3 - 5、30 - 50或80 - 100mg/kg/天阿司匹林治疗的患者。与安慰剂相比，不同剂量阿司匹林的CAL风险无显著差异：3 - 5mg/kg/天阿司匹林治疗的患者，比值比（OR）为1.10[95%置信区间（CI）：0.70 - 1.71]；30 - 50mg/kg/天阿司匹林治疗的患者，OR = 1.23（95%CI：0.67 - 2.26）；80 - 100mg/kg/天阿司匹林治疗的患者，OR = 1.59（95%CI：0.74，3.421）。P值范围从安慰剂组的0.76到80 - 100mg/kg/天阿司匹林组的0.19。不同剂量的阿司匹林在CAL疗效、静脉注射免疫球蛋白抵抗或急性KD住院时间等次要结局方面无显著差异。因此，我们发现不使用任何阿司匹林治疗并不劣于其他剂量的阿司匹林，并且还可略微降低CAL风险。
