背景:与SARS-CoV-2相关的儿童多系统炎症综合征(MIS-C)可导致严重的心血管并发症。Anakinra,白细胞介素-1受体拮抗剂,被提议有益于MIS-C的高炎症状态,可能改善心脏功能。这项系统评价评估了早期Anakinra给药对MIS-C儿童心脏预后的有效性。
方法:对PubMed的全面搜索,Embase,和WebofScience直到2024年3月才确定了使用Anakinra治疗MIS-C的研究,并报告了心脏结局。包括观察性队列和临床试验,数据提取侧重于心脏功能指标和炎症标志物。使用纽卡斯尔-渥太华量表评估研究质量。
结果:六项研究符合纳入标准,从回顾性队列到前瞻性临床研究,主要来自美国。根据疾病严重程度,Anakinra的剂量范围为2.3至10mg/kg。多项研究显示左心室射血分数显著改善,炎症标志物如C反应蛋白降低,提示Anakinra在增强心脏功能和减轻炎症中的作用。然而,关于血管活性支持需求的发现好坏参半,一些研究没有报告急性心脏支持需求的显著变化.
结论:阿纳金拉早期给药显示出改善MIS-C患儿心功能和减轻炎症的潜力,尤其是那些有严重表现的人。然而,现有证据受到大多数研究的观察性限制,缺乏随机对照试验(RCT).需要进一步的高质量随机对照试验来最终确定Anakinra的有效性,并优化其在MIS-C管理中的使用,以获得更好的长期心脏结果和标准化治疗方案。
BACKGROUND: Multisystem Inflammatory Syndrome in Children (MIS-C) associated with SARS-CoV-2 can lead to severe cardiovascular complications. Anakinra, an interleukin-1 receptor antagonist, is proposed to benefit the hyperinflammatory state of MIS-C, potentially improving cardiac function. This systematic review evaluated the effectiveness of early Anakinra administration on cardiac outcomes in children with MIS-C.
METHODS: A comprehensive search across PubMed, Embase, and Web of Science until March 2024 identified studies using Anakinra to treat MIS-C with reported cardiac outcomes. Observational cohorts and clinical trials were included, with data extraction focusing on cardiac function metrics and inflammatory markers. Study quality was assessed using the Newcastle-Ottawa Scale.
RESULTS: Six studies met the inclusion criteria, ranging from retrospective cohorts to prospective clinical studies, predominantly from the USA. Anakinra dosages ranged from 2.3 to 10 mg/kg based on disease severity. Several studies showed significant improvements in left ventricular ejection fraction and reductions in inflammatory markers like C-reactive protein, suggesting Anakinra\'s role in enhancing cardiac function and mitigating inflammation. However, findings on vasoactive support needs were mixed, and some studies did not report significant changes in acute cardiac support requirements.
CONCLUSIONS: Early Anakinra administration shows potential for improving cardiac function and reducing inflammation in children with MIS-C, particularly those with severe manifestations. However, the existing evidence is limited by the observational nature of most studies and lacks randomized controlled trials (RCTs). Further high-quality RCTs are necessary to conclusively determine Anakinra\'s effectiveness and optimize its use in MIS-C management for better long-term cardiac outcomes and standardized treatment protocols.