A Meta Analysis Of Re-treatment For Immunoglobulin-resistant Kawasaki Disease

Objective:The current standard method of treatment of Kawasaki disease is the use of high doses of gamma globulin (2g/kg) and aspirin, but there are still15%-25%of patients no response on the gamma globulin, leading fever or even the further damage of the coronary arteries. This study will use the meta-analysis of the evidence-based medicine to explore the advantages and disadvantages of either glucocorticosteroid or repeated intravenous gamma globulin in treating these cases.Methods:This study selected six research groups which are related to the patients with Kawasaki disease who failed to respond to the initial intravenous gamma globulin treatment; Then use the meta analysis to compare the two kinds of treatment in the aspects of damage of the coronary arteries, fever duration and serum CRP levels.Results:8research groups include404patients for analysis.175patients were received intravenous glucocorticosteroid and229cases were given repeated intravenous gamma globulin. In comparison of intravenous glucocorticosteroid versus repeated intravenous gamma globulin, OR for the damage of the coronary arteries0.88(95%CI,0.52-1.48)>0with rhombus intersection with the vertical line, WMD for fever duration is WMD=-1.91(95%CI,-2.88—-0.95)<0)<0with rhombus situated to the left side of the vertical line. WMD for the serum CRP levels isWMD=-3.94(95%CI,-5.42—-2.45)<0with rhombus entirely situated to the left side of the vertical line. WMD for the hospital costs isWMD=-87.57(95%CI101.27—-73,87)<0with rhombus entirely situated to the left side of the vertical line.Conclusion:Both efficacy in reducing coronary artery injury are no significant difference, but in terms of fever, reduce the effect of CRP and hospital costs are the significant differences.