Rauniyar Robin, Mishra Aman, Kharel Sanjeev, Giri Subarna, Rauniyar Rohit, Yadav Shikha, Chaudhary Gajendra
Maharajgunj Medical Campus, Tribhuvan University, Institute of Medicine, Kathmandu, Nepal.
Internal Medicine, McLaren Flint/Michigan State University (MSU), Flint, MI, USA.
Can J Infect Dis Med Microbiol. 2022 Mar 29;2022:9458653. doi: 10.1155/2022/9458653. eCollection 2022.
There is limited information available regarding the management of multisystem inflammatory syndrome in children (MIS-C) associated with SARS-CoV-2. We performed a systematic review and meta-analysis to evaluate the optimal treatment using IVIG alone versus IVIG plus glucocorticoids.
PubMed, Google Scholar, EMBASE, and Cochrane databases were searched along with other secondary searches. Studies published within the time frame of January 2020 to August 2021 were included. We screened records, extracted data, and assessed the quality of the studies using NOS. Studies that directly compare the two treatment groups were included. Analyses were conducted using the random-effects model (DerSimonian-Laird analysis) if > 50% and fixed-effects model was used if < 50%.
We included three studies in the final quantitative analysis. The initial therapy with the IVIG plus glucocorticoids group significantly lowered the risk of treatment failure (OR 0.57, 95% CI (0.42, 0.79), 45.36%) and the need for adjunctive immunomodulatory therapy (OR 0.27, 95% CI (0.20, 0.37), 0.0%). The combination therapy showed no significant reduction in occurrence of left ventricular dysfunction (OR 0.79, 95% CI (0.34, 1.87), 58.44%) and the need for inotropic support (OR 0.83, 95% CI (0.35, 1.99), 75.40%).
This study supports the use of IVIG with glucocorticoids compared to IVIG alone, as the combination therapy significantly lowered the risk of treatment failure and the need for adjunctive immunomodulatory therapy.
关于与严重急性呼吸综合征冠状病毒2（SARS-CoV-2）相关的儿童多系统炎症综合征（MIS-C）的管理，现有信息有限。我们进行了一项系统评价和荟萃分析，以评估单独使用静脉注射免疫球蛋白（IVIG）与IVIG加糖皮质激素的最佳治疗方法。
检索了PubMed、谷歌学术、EMBASE和Cochrane数据库以及其他二次检索。纳入2020年1月至2021年8月期间发表的研究。我们筛选记录、提取数据，并使用纽卡斯尔-渥太华量表（NOS）评估研究质量。纳入直接比较两个治疗组的研究。如果I²>50%，则使用随机效应模型（DerSimonian-Laird分析）进行分析；如果I²<50%，则使用固定效应模型。
我们在最终的定量分析中纳入了三项研究。IVIG加糖皮质激素组的初始治疗显著降低了治疗失败的风险（比值比[OR]0.57，95%置信区间CI，I²45.36%）和辅助免疫调节治疗的需求（OR 0.27，95%CI(0.20,0.37)，I²0.0%）。联合治疗在左心室功能障碍的发生率（OR 0.79，95%CI(0.34,1.87)，I²58.44%）和使用正性肌力支持的需求方面没有显著降低（OR 0.83，95%CI(0.35,1.99)，I²75.40%）。
本研究支持与单独使用IVIG相比，使用IVIG联合糖皮质激素，因为联合治疗显著降低了治疗失败的风险和辅助免疫调节治疗的需求。
