Abstract：
To compare the efficacy and safety of intravenous immunoglobulins (IVIG) and anti-D immunoglobulin (anti-D) in pediatric immune thrombocytopenia (ITP).
We conducted a systematic review and meta-analysis following PRISMA guidelines, including all randomized controlled trials that have assessed the efficacy and safety of anti-D and IVIG in children with ITP. We searched Medline, Embase, and Cochrane databases. Primary outcomes were the proportion of children achieving platelet count responses as defined in each study and bleeding response. Other safety outcomes included infusion reactions and hemolysis.
Eleven studies with 558 children were included. Anti-D was significantly inferior to IVIG at increasing platelet counts, both for thresholds of >20 × 109/L at 24-72 hours (response rate ratio for anti-D vs IVIG: 0.85, 95% CI 0.78-0.94) and >50 × 109/L at 24-72 hours (response rate ratio for anti-D vs IVIG: 0.75, 95% CI 0.61-0.92). Bleeding response was assessed in 4 studies, but some heterogeneity in reporting leads to unclear conclusion. General symptoms after anti-D infusion were less frequent than after IVIG (Peto OR 0.39, 95% CI 0.25-0.62). Hemolysis was more frequent after anti-D. The overall quality of the studies was low.
Compared with anti-D, IVIG led to a better response in terms of platelet count and may be preferred as a first-line treatment of ITP in children with acute hemorrhagic symptoms. However, the clinical significance of IVIG superiority on platelet count remains unclear.
We conducted a systematic review and meta-analysis following PRISMA guidelines, including all randomized controlled trials that have assessed the efficacy and safety of anti-D and IVIG in children with ITP. We searched Medline, Embase, and Cochrane databases. Primary outcomes were the proportion of children achieving platelet count responses as defined in each study and bleeding response. Other safety outcomes included infusion reactions and hemolysis.
Eleven studies with 558 children were included. Anti-D was significantly inferior to IVIG at increasing platelet counts, both for thresholds of >20 × 109/L at 24-72 hours (response rate ratio for anti-D vs IVIG: 0.85, 95% CI 0.78-0.94) and >50 × 109/L at 24-72 hours (response rate ratio for anti-D vs IVIG: 0.75, 95% CI 0.61-0.92). Bleeding response was assessed in 4 studies, but some heterogeneity in reporting leads to unclear conclusion. General symptoms after anti-D infusion were less frequent than after IVIG (Peto OR 0.39, 95% CI 0.25-0.62). Hemolysis was more frequent after anti-D. The overall quality of the studies was low.
Compared with anti-D, IVIG led to a better response in terms of platelet count and may be preferred as a first-line treatment of ITP in children with acute hemorrhagic symptoms. However, the clinical significance of IVIG superiority on platelet count remains unclear.
摘要：
比较静脉注射免疫球蛋白(IVIG)和抗D免疫球蛋白(anti-D)治疗小儿免疫性血小板减少症(ITP)的疗效和安全性。
我们遵循PRISMA指南进行了系统评价和荟萃分析，包括所有评估抗D和IVIG治疗儿童ITP疗效和安全性的随机对照试验。我们搜查了Medline,Embase,和Cochrane数据库。主要结果是达到各项研究中定义的血小板计数反应和出血反应的儿童比例。其他安全性结果包括输注反应和溶血。
纳入了11项558名儿童的研究。抗D在增加血小板计数时明显不如IVIG，在24-72小时阈值均>20×109/L（抗D与IVIG的缓解率：0.85，95％CI0.78-0.94）和在24-72小时>50×109/L（抗D与IVIG的缓解率：0.75，95％CI0.61-0.92）。在4项研究中评估了出血反应，但报告中的一些异质性导致结论不明确。抗D输注后的一般症状频率低于IVIG后（PetoOR0.39，95％CI0.25-0.62）。抗D后溶血更频繁。研究的总体质量较低。
与反D相比，IVIG在血小板计数方面产生了更好的反应，并且可以优选作为具有急性出血症状的儿童ITP的一线治疗。然而,IVIG对血小板计数的优越性的临床意义尚不清楚.
我们遵循PRISMA指南进行了系统评价和荟萃分析，包括所有评估抗D和IVIG治疗儿童ITP疗效和安全性的随机对照试验。我们搜查了Medline,Embase,和Cochrane数据库。主要结果是达到各项研究中定义的血小板计数反应和出血反应的儿童比例。其他安全性结果包括输注反应和溶血。
纳入了11项558名儿童的研究。抗D在增加血小板计数时明显不如IVIG，在24-72小时阈值均>20×109/L（抗D与IVIG的缓解率：0.85，95％CI0.78-0.94）和在24-72小时>50×109/L（抗D与IVIG的缓解率：0.75，95％CI0.61-0.92）。在4项研究中评估了出血反应，但报告中的一些异质性导致结论不明确。抗D输注后的一般症状频率低于IVIG后（PetoOR0.39，95％CI0.25-0.62）。抗D后溶血更频繁。研究的总体质量较低。
与反D相比，IVIG在血小板计数方面产生了更好的反应，并且可以优选作为具有急性出血症状的儿童ITP的一线治疗。然而,IVIG对血小板计数的优越性的临床意义尚不清楚.
