| Background In recent years, the number of researches which treat Kawasaki disease (KD) with glucocorticoids (GCs) is gradually increasing, but the results obtained are controversial, the efficacy and safety of the treatment are not fully understood.Objectives1. Evaluate the efficacy of GCs with regard to the prevalence of coronary artery lesion (CAL), duration of fever, changes in blood and biochemical tests.2. Evaluate the safety of GCs in the treatment of Kawasaki disease, particularly in the inducement of CAL, compared with intravenous immunoglobulin(IVIG), aspirin and other drugs.Methods Kawasaki disease, steroids, glucocorticoids, corticosteroids, adreno-corticotropic hormone, dexamethasone, prednisone, hydrocortisone, prednisolone, and methylprednisolone are used as the search terms in the full-text field from 14 electronic databases, hand searched three kinds of Japanese magazines, the randomized controlled trials (RCT) or quasi-randomized controlled trials that describe the use of GCs for the treatment of Kawasaki disease in children were sought. The outcome measures included:1, primary outcome:the incidence of CAL, including coronary artery dilation and coronary artery aneurysms; 2, secondary outcome:the duration of fever after treatment, blood and biochemical test results such as C-reactive protein(CRP) and erythrocyte sedimentation rate (ESR), response to treatment, and adverse effects. Data on methodological quality and trial information was extracted by two researchers separately. Cochrane review methodology was used for assessing trial quality and effectiveness. Each dichotomous outcome will be measured in terms of odds risk, continuous outcomes will be shown as weighted mean differences and combined for meta-analysis with RevMan5.0.23.0 software. Fixed-effect approach will be used unless there is significant heterogeneity, in which case results will be confirmed using a random-effects statistical model. We also performed sensitivity analysis on results to look at the possible contribution of differences in methodological quality, the outcomes were pooled statistically too. Funnel plot was used to analysis the publication bias.Results1.1105 cases in 15 trails were included, of which 547 cases in GCs therapy group and 558 cases in control group. In 6 trials, GCs was used to treat Kawasaki disease alone, GCs in addition to IVIG treatment on Kawasaki disease with IVIG alone were compared in 5 trials,4 tests evaluated the effect of GCs in IVIG unresponsive Kawasaki disease.2.6 articles describe the random method,3 papers report withdrawals and drop-outs, two research use intention to treat analysis, only one study use allocation concealment and blinding in the test. Jadad score 3-5 points in 4 papers,1-2 points in 10 papers. 3. General analysis showed that the incidence of CAL in GCs group is lower than control group within 1 month after treatment (p<0.05); subgroup analysis showed that the incidence of CAL is not different between GCs group and control group (p>0.05).4. The incidence of CAL is not different between GCs group and control group 1 month after treatment (p>0.05).5. General analysis showed that the fever duration in GCs group is shorter than control group (p<0.05). Subgroup analysis showed that in the patients who was initially treated by GCs alone, the difference is not significant (p>0.05). But in the other patients, fever time is significantly shorter in GCs group (p<0.05).6.3 days after treatment, the fever patients in GCs group is less than control group (p<0.05).7. Treatment failure rate in GCs group is less than control group (p<0.05).8. General analysis shows, in GCs group, the level of ESR after 2 weeks of treatment lower than control group (p<0.05), subgroup analysis get the same result except in IVIG resistant KD patirnt.9. After 1 week of treatment, the level of CRP in GCs group is lower than control group (p<0.05).10. The adverse events in two groups is not different (p>0.05).11. Excluded the low-quality trials which Jada score less than 3, the incidence of adverse effect and CAL in GCs group are not different from control group (p>0.05); fever duration is significantly shorter than the control group (p<0.05); treatment failure rate lower than control group (p<0.05).12. The funnel plot analysis suggests that publication bias exists.Conclusions1. This study shows that there is no evidence to support the GCs can reduce the CAL risk of patients with KD.2. In KD patients, GCs in addition to IVIG can reduce fever duration, decrease CRP and ESR levels, and reduce treatment failure rate further.3. GCs can not increase the risk of CAL in KD patients. Objectives1. To study the clinic features of coronary artery lesion (CAL) in Kawasaki disease (KD).2. To observe the changes of laboratory examination and coronary artery induced by intravenous immunoglobulin (IVIG) on patients with KD.3. To investigate the clinical features of incomplete Kawasaki disease (IKD). Methods The clinic information, laboratory examination and follow-up results of 57 KD patients and control group of 24 non-infectious patients were analyzed retrospectively.Results1. There is no significant difference in gender and age between KD and control group (p>0.05).2. Echocardiography was performed in 52 patients,30 in non-coronary artery lesion group (NCAL),22 in CAL group. The frequency of perianal skin desquamation, and lesions of lips and oral cavity are less than CAL group (p<0.05). The time of fever, the level of white blood cells(WBC), C-reactive protein(CRP), and aspartate aminotransferase(AST)in CAL group are significantly higher than NCAL group (p <0.05), in patients with coronary artery dilation (CAD), left coronary artery (LCA) is more susceptive to dilation than right coronary artery (RCA) (p<0.01).3. In CAD patients, the diameter of LCA and RCA were significantly recovery 6 to 18 days after IVIG treatment (p<0.05), while that of CAA patients did not change significantly (p>0.05).4. Before treatment, WBC and the proportion of neutrophil (N%) in KD group were higher than controls(p<0.05), while the proportion of lymphocytes(L%) was lower than control group(p<0.05). In KD group, after IVIG treatment, WBC and N% decreased significantly, L% and PLT increased significantly(p<0.05), CRP was significantly decreased 1 week after treatment, erythrocyte sedimentation rate (ESR) was significantly decreased 2 weeks after treatment (p<0.05).5.41 of 57 KD patients were classic Kawasaki disease (CKD),16 of them were incomplete Kawasaki disease (IKD). In IKD group, the fever duration is longer than CKD group, the frequency of conjunctival congestion, indurative edema of palms and soles, and changes of lips and oral cavity are less than CKD group (p<0.05). The incidence of CAL and IVIG resistance in IKD group is higher than CKD group (p<0.05).6.33 KD patients were followed up, no new impairment occurred in 18 NCAL cases, the dilated coronary artery in 13 patients with CAD regressed completely,1 coronary artery aneurysms (CAA) lesion deteriorated,1 CAA lesion was reduced.Conclusions1. Long duration of fever, high value of WBC, CRP, and AST are the risk factors of CAL secondary to KD. 2. IVIG is an effective agent in the treatment of KD, WBC, N%, L%, CRP and ESR returned to normal, but the platelet increased gradually.3. Although IKD don't fulfill the Classic diagnostic criteria of KD, the risk of CAL is higher than CKD. Moreover, IKD is not sensitive to IVIG, so the doctors should pay more attention to it.
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