摘要
目的 基于循证医学方法对静注人免疫球蛋白(IVIG)治疗新型冠状病毒感染(COVID-19)的有效性进行评价,为临床合理用药提供参考。方法 利用EviMed循证评价决策系统与人工检索相结合,检索PubMed、Cochrane Library、中国知网及万方等数据库和临床试验注册网站,汇总分析相关文献及临床试验。通过AGREEⅡ评价工具对临床指南进行质量评价,AMSTAR2量表和GRADE分级系统分别对纳入的系统评价/meta分析进行方法学和证据质量进行评价。判定循证医学证据并提出推荐建议。结果 除治疗儿童多系统炎症综合征(MIS-C)外,目前并无相关指南对IVIG用于COVID-19做出明确推荐。中国台湾地区诊疗方案和中华医学会呼吸病学分会明确不推荐使用IVIG治疗COVID-19。4篇系统评价/meta分析显示,IVIG治疗COVID-19并没有改善临床结局,2篇文献显示IVIG能降低COVID-19危重型患者的死亡率,但证据质量较低。结论IVIG治疗COVID-19的有效性还缺乏明确的证据支持,暂不推荐常规使用IVIG。
Objective To evidence-based evaluate the clinical effect of human intravenous immunoglobulin(IVIG) in the treatment of patients with corona virus disease 2019(COVID-19), so as to provide references for clinical rational drug use.Methods The EviMed system combined manual retrieval was used to search PubMed, Cochrane Library, CNKI, Wanfang, and other databases and clinical trial registration websites, and the literatures and clinical trials were analyzed. The AGREEⅡevaluation tool was used to evaluate the quality of the guidelines. The AMSTAR2 scale and the GRADE rating system were used to evaluate the methodological and evidence quality of the systematic reviews/meta-analyses, respectively. Recommendations were made based on evidence-based medical evidence. Results At present, there are no specific guidelines to recommend IVIG for the treatment of COVID-19, except for multisystem inflammatory syndrome in children(MIS-C). The Taiwan Con?sensus of the People’s Republic of China and the Chinese Medical Association Respiratory Branch explicitly do not recommend IVIG for the treatment of COVID-19. Four systematic reviews/meta-analyses showed that IVIG did not improve clinical out?comes. Two systematic reviews have shown that IVIG can reduce mortality in critically patients with COVID-19, but the evi?dence level was low. Conclusion The effectiveness of IVIG for the treatment of COVID-19 lacks definitive evidence support, and conventional use of IVIG is not recommended.
作者
武明芬
孙阿宁
李草
张伊楠
朱斌
赵志刚
WU Ming-fen;SUN A-ning;LI Cao;ZHANG Yi-nan;ZHU Bin;ZHAO Zhi-gang(Department of Pharmacy,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)
出处
《临床药物治疗杂志》
2023年第1期10-15,共6页
Clinical Medication Journal
基金
中国毒理学会临床毒理专项研究(CST2019CT302)。
关键词
新型冠状病毒感染
静注人免疫球蛋白
循证评价
corona virus disease 2019
numan intravenous immunoglobulin
evidence-based evaluation
