Glucocorticoid versus intravenous injection of human immunoglobulin in treatment of primary immune ;thrombocytopenia in children：a meta-analysis
10.3969/j.issn.1000-3606.2016.09.015
- VernacularTitle:糖皮质激素与静脉注射人免疫球蛋白治疗儿童原发性免疫性血小板减少症meta分析
- Author:
Min YANG
;
Wenjun LIU
;
Yongqi BAI
;
Qulian GUO
- Publication Type:Journal Article
- Keywords:
glucocorticoid;
intravenous immunoglobulin;
thrombocytopenia;
child
- From:
Journal of Clinical Pediatrics
2016;34(9):696-704
- CountryChina
- Language:Chinese
-
Abstract:
Objective To compare the effectiveness and safety of glucocorticoid versus intravenous injection of human immunoglobulin (IVIG) in treatment of with acute primary immune thrombocytopenia (ITP) in children. Methods PubMed, the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, Chinese biomedical literature database (CBM), Chinese Journal Full Text Database (CNKI) and Wanfang database were searched. The bibliography was screened according to the inclusion and exclusion criteria,and the target literatures were selected. The data were extracted and the quality of included literatures was evaluated. Revman 5 . 3 software was used to make meta-analysis. Results In 1500 papers searched, 8 papers met the inclusion criteria. Meta-analysis showed that there was a statistical signiifcance in platelet count (PLT,>20 × 109/L) after being treated for 48 h between glucocorticoid group and IVIG group (RR=0 . 77 , 95%CI:0 . 67~0 . 89 ). In subgroup analysis, there were statistical signiifcance in methylprednisolone (MP) 30 mg/kg versus IVIG 1 g/(kg·d)× 2 d, and metacortandratin (PDN) 4 mg/kg versus IVIG 1 g/(kg·d)× 2 d (RR=0 . 66 , 95%CI:0 . 47-0 . 91;RR=0 . 79 , 95%CI:0 . 66-0 . 95 ). After treatment for 24 h and 72 h, the platelet count>20 × 109/L were signiifcantly different in glucocorticoid group and in IVIG group (RR=0 . 69 , 95%CI:0 . 53-0 . 91;RR=0 . 82 , 95%CI:0 . 74-0 . 90 ). Moreover, after treatment for 24 h, 48 h and 72 h, the platelet count>50 × 109/L were signiifcantly different between glucocorticoid group and IVIG group (RR=0 . 38 ,95%CI:0 . 21-0 . 69;RR=0 . 53 , 95%CI:0 . 41-0 . 69;RR=0 . 80 , 95%CI:0 . 70-0 . 93 ). There was no difference in the incidence of splenic resection between two groups (RR=5 . 41 , 95%CI:0 . 95-30 . 74 , P=0 . 06 ). Conclusion The probability of platelet count to reach>20 × 109/L in the initial treatment with glucocorticoid of acute ITP patients were 32%lower than that with IVIG. With the initial therapeutic target being platelet count>50 × 109/L in 3 days, the effect of IVIG was better.
