A Meta-analysis Of IVIG Combined With Corticosteroid On Coronary Artery Lesion In Kawasaki Disease And The Analysis On Risk Factors Of Coronary Artery Lesion In Kawasaki Disease

Objective:Although corticosteroids are widely used in many vasculitis, the use in Kawasaki disease (KD) is still controversial. To investigate the overall efficacy of intravenous immune globulin (IVIG) plus corticosteroid in the primary treatment or treatment for IVIG-resistant patients, we conducted this meta-analysis. We also investigated the clinical characters of KD patients treated in our hospital to provide clinical evidence to prevent or treat KD.Methods:The first part:By searching Cochrane library, PubMed, Embase Database, we selected clinical trials of IVIG plus corticosteroid versus IVIG alone for the treatment of Kawasaki disease. The coronary outcome and the rates of unresponsive patients were analyzed.The second part:A total of 101 patients were randomly selected in our database. We retrospectively investigated the clinical characteristics of these patients to figure out.the risk factors of coronary artery lesion (CAL).Results:1、18 studies with a total of 2157 patients were enrolled. The meta-analysis revealed that IVIG plus corticosteroid therapy significantly reduced the risk of coronary artery lesion for both up to a month (OR=0.40,95% CI 0.21-0.75, P=0.004) and over one month(OR= 0.42,95% CI 0.26-0.70, p<0.001).There was also a notably reduction in the rates of initial treatment failure among patients who received steroid combined therapy(OR=0.35,95% CI 0.22-0.54, p<0.001). Besides, a significant decrease was noted in the incidence of CAL among IVIG non-responders retreated with corticosteroids (OR=0.57,95% CI 0.36-0.92, p=0.02). However, IVIG plus corticosteroid did not improve the unresponsive rates for IVIG-resistant patients (OR=0.79,95% CI 0.14-4.30, p=0.78).2、We analyzed 101 hospitalized KD patients, including 33 patients with CAL and 68 without CAL. After Chi-square test and multiple logistic regression analysis, age and albumin were found to be significantly related to CAL.Conclusions:1、Combination of corticosteroid with IVIG as initial treatment could reduce both the risk of CAL and the rates of treatment resistance. And for IVIG-resistant patients, the addition of corticosteroid to standard therapy could improve coronary outcome without reducing the number of cases requiring retreatment.2、The clinical data showed that the age and albumin were the risk factors for CAL in KD.