Efficacy between low and high dose aspirin for the initial treatment of Kawasaki disease: Current evidence based on a meta-analysis
Efficacy between low and high dose aspirin for the initial treatment of Kawasaki disease: Current evidence based on a meta-analysis
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低剂量和高剂量阿司匹林用于川崎病初始治疗的疗效：基于荟萃分析的当前证据
DOI：
10.1371/journal.pone.0217274
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发表时间：
2019-05-22
期刊：
影响因子：
3.7
通讯作者：
Li, Yifei
中科院分区：
文献类型：
--
作者：
Zheng, Xiaolan;Yue, Peng;Li, Yifei
背景川崎（KD）是目前发达国家儿童获得性心脏病的主要病因。静脉注射免疫球蛋白（IVIG）和阿司匹林被认为是几十年来KD的标准初始治疗。然而，阿司匹林的最佳剂量仍然存在争议。近年来，许多研究比较了小剂量和大剂量阿司匹林在KD急性期的疗效，但结果并不总是一致的。因此，我们进行了这项荟萃分析，以评估低剂量阿司匹林与高剂量阿司匹林相比在KD初始治疗中的疗效。方法从PubMed、EMBASE、科克伦对照试验中心、中国知网和Google scholar中检索到2019年3月25日之前与阿司匹林治疗KD相关的研究。使用STATA版本15.1分析数据。此外，还通过STATA版本15.1进行了发表偏倚和敏感性分析。结果6项研究纳入我们的冠状动脉病变（CAL）率分析，5项报告IVIG抵抗KD（rKD），4项报告发热和住院时间。但是，低剂量和高剂量阿司匹林组CAL的发生率无显著差异（风险比（RR），0.85; 95%CI（0.63，1.14）; P = 0.28），rKD的风险（RR，1.39; 95%CI（1.00，1.93）; P = 0.05）、发热和住院时间（平均标准差（SMD），0.03; 95%CI（-0.16，0.22）; P = 0.78）。结论小剂量阿司匹林（3-5 mg·kg-1·d-1）与大剂量阿司匹林（≥30 mg·kg-1·d-1）治疗川崎病的疗效相当。需要进一步设计良好的随机临床试验来评估低剂量阿司匹林对KD初始治疗的有效性。
Background Kawasaki disease (KD) is now the leading cause of acquired heart disease in children in developed countries. Intravenous immunoglobulin (IVIG) and aspirin were considered as the standard initial treatment of KD for decades. However, the optimal dose of aspirin has remained controversial. In recent years, many studies compared the efficacy of low-dose with high-dose aspirin in the acute phase of KD, but the results have not always been consistent. Therefore, we performed this meta-analysis to evaluate the efficacy of low-dose aspirin compared with high-dose for the initial treatment of KD. Methods Studies related to aspirin therapy for KD were selected from PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, and Google scholar through Mar 25th, 2019. Data were analyzed using STATA Version 15.1. Additionally, publication bias and sensitivity analysis were also performed by STATA version 15.1. Results Six studies were included in our analysis of the rate of coronary artery lesion (CAL), five reports for IVIG-resistant KD (rKD), and four for the duration of fever and hospitalization. However, no significant differences were found between low-dose and high-dose aspirin groups in the incidence of CAL (risk ratio (RR), 0.85; 95%CI (0.63, 1.14); P = 0.28), the risk of rKD (RR, 1.39; 95%CI (1.00, 1.93); P = 0.05), and duration of fever and hospitalization (the mean standard deviation (SMD), 0.03; 95%CI (-0.16, 0.22); P = 0.78). Conclusion Low-dose aspirin (3–5 mg·kg-1·d-1) may be as effective as the use of high-dose aspirin (≥30 mg·kg-1·d-1) for the initial treatment of KD. Further well-designed randomized clinical trials are needed to evaluate the efficacy of low-dose aspirin for the initial treatment of KD.