鼠神经生长因子联合丙种球蛋白治疗儿童吉兰-巴雷综合征的Meta分析

李春梅; 刘振奎; 卢艳辉; 李文斌; 王艳飞; 曹燕玲; 高娇娇

doi:10.3969/j.issn.2095-5227.2020.02.023

鼠神经生长因子联合丙种球蛋白治疗儿童吉兰-巴雷综合征的Meta分析

Mouse nerve growth factor combined with immunoglobulin in treatment of Guillain-Barre syndrome in children: A meta-analysis

摘要

摘要: 目的系统评价鼠神经生长因子(mouse nerve growth factor,mNGF)联合丙种球蛋白(intravenous immunoglobulin,IVIG)对吉兰-巴雷综合征(Guillian-Barre syndrome,GBS)患儿的疗效。方法检索2019年6月前维普、万方数据库、中国知网、中国生物医学文献数据库、Pubmed、Medline、Embase相关随机对照试验,应用RevMan5.2软件对其进行Meta分析。结果共计10篇中文文献,713例患者符合纳入标准。Meta分析结果显示mNGF联合IVIG的治疗组总有效率高于单独IVIG对照组OR=4.54,95% CI(2.47,8.33),P<0.01。治疗后,治疗组的Hughes肢体运动功能恢复明显优于对照组WMD=-1.08,95% CI(-1.49,-0.66),P<0.01;IL-12WMD=-16.47,95% CI(-18.08,-14.86),P<0.01、IL-18WMD=-28.35,95% CI(-35.04,-21.66),P<0.01、IL-21WMD=-73.59,95% CI(-82.52,-64.66),P<0.01、IL-23WMD=-372.78,95% CI(-416.81,-328.76),P<0.01水平均较对照组降低明显;上肢WMD=0.39,95% CI(0.22,0.56),P<0.01及下肢WMD=0.53,95% CI(0.28,0.78),P<0.01肌力评分均显著高于对照组;呼吸肌麻痹WMD=-8.42,95% CI(-11.36,-5.48),P<0.01、肌张力WMD=-7.40,95% CI(-11.11,-3.69),P<0.01、腱反射WMD=-10.79,95% CI(-15.93,-5.65),P<0.01、感觉障碍WMD=-9.25,95% CI(-10.33,-8.17),P<0.01及四肢疼痛WMD=-13.16,95% CI(-15.13,-11.19),P<0.01恢复时间均显著小于对照组;神经传导速度显著快于对照组WMD=4.52,95% CI(2.31,6.74),P<0.01。两组的不良反应发生率无统计学差异WMD=2.03,95% CI(0.76,5.41),P=0.16。结论 mNGF联合IVIG用于儿童GBS的治疗,对改善症状、提高疗效、降低患儿全身炎症反应有显著作用。

Abstract: Objective To systematically evaluate the efficacy of mouse nerve growth factor (mNGF) combined with intravenous immunoglobulin (IVIG) for Guillian-Barre syndrome (GBS) in children. Methods We searched Chinese Knowledge Network (CNKI),Wanfang Database,China Biomedical Literature Database (CBM),VIP Chinese Science,Pubmed,Medline and Embase to collect relevant randomized controlled trials before June 2019.The meta-analysis of the included randomized controlled trials was performed with RevMan 5.2 software. Results Ten literatures in Chinese (713 cases) were enrolled in this study.Meta analysis showed that the therapeutic efficacy of mNGF+IVIG (the treatment group) was obviously superior to that of IVIG (the control group) (OR,4.54;95% CI 2.47,8.33,P<0.01).After treatment,Hughes limb motor function of cases in the treatment group was better than that of the control group (WMD=-1.08,95% CI -1.49,-0.66,P<0.01).Serum levels of IL-12 (WMD=-16.47,95% CI -18.08,-14.86,P<0.01),IL-18 (WMD=-28.35,95% CI -35.04,-21.66,P<0.01),IL-21 (WMD=-73.59,95% CI -82.52,-64.66,P<0.01),IL-23 (WMD=-372.78,95% CI -416.81,-328.76,P<0.01) in the treatment group were significantly lower than those in the control group.The muscle strength grade of upper (WMD=0.39,95% CI 0.22,0.56,P<0.01) and lower limbs (WMD=0.53,95% CI 0.28,0.78,P<0.01) in the treatment group were significantly higher than those of the control group.The recovery time of respiratory muscle paralysis (WMD=-8.42,95% CI (-11.36,-5.48,P<0.01),muscle tension WMD=-7.40,95% CI -11.11,-3.69,P<0.01),tendon reflexes (WMD=-10.79,95% CI -15.93,-5.65,P<0.01),sensory disturbance (WMD=-9.25,95% CI -10.33,-8.17,P<0.01) and pain in the limbs (WMD=-13.16,95% CI -15.13,-11.19,P<0.01) in the treatment group was significantly less than that of the control group.The nerve conduction velocity of the treatment group was significantly faster than that of the control group (WMD=4.52,95% CI 2.31,6.74,P<0.01).However,there was no significant difference in the incidence of adverse reactions between the two groups (WMD=2.03,95% CI 0.76,5.41,P=0.16). Conclusion Mouse nerve growth factor combined with immunoglobulin treatment can reduce systemic inflammatory,improve symptoms and therapeutic efficacy in children with GBS.

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