| Objective In this study,a meta-analysis of related studies published in the relevant domestic and foreign literatures was performed to compare the effectiveness of Intravenous immunoglobulin combined with glucocorticoids,IVIG,glucocorticoids,and TNF-αantagonists on Stevens-Johnson syndrome and Toxic Epidermal Necrolysis.Through comparison of different treatment schemes,the aim is to provide a more accurate evaluation of the clinical treatment of SJS / TEN.Methods A comprehensive search of domestic and foreign literature from January1990 to December 2019 on the Pubmed database,Embase database,Cochrance Library database and Wanfang Medical Database,China National Knowledge Infrastructure.Literature screening and data extraction were performed according to the inclusion criteria.We divide the treatment plan into four groups,a meta-analysis was performed on the literature included in the IVIG combined glucocorticoids group,the IVIG group,and the glucocorticoids group in each group to select the optimal solution.Finally,the optimal treatment plan and TNF-α antagonist were meta-analyzed again,and the best treatment plan for SJS / TEN was finally selected.Results 1.Meta-analysis comparison of the effects of IVIG combined glucocorticoids group and glucocorticoids group on the time to stop disease progression and length of hospital stay: Compared with glucocorticoids therapy,IVIG combined glucocorticoids therapysignificantly shortened the time to stop disease progression and length of hospital stay(both P<0.05);Compared with glucocorticoids therapy,the benefits of IVIG combined glucocorticoids are significant in Asian and North American populations,while the benefits of IVIG combined hormones are not significant in European populations(all P <0.05);regardless of IVIG dose,IVIG combined glucocorticoids therapy than glucocorticoids therapy can effectively shorten the disease progression and hospital stay(both P <0.05).2.Metaanalysis comparison of the influence of IVIG group and glucocorticoids group on hospitalization time and mortality: IVIG treatment alone has longer hospital stay and increased mortality(all P <0.05)compared with glucocorticoids treatment.3.Meta-analysis comparison of the effects of IVIG combined glucocorticoids and IVIG alone on SMR: IVIG combined glucocorticoids significantly reduced mortality compared with IVIG alone(P<0.05);IVIG alone could not effectively improve mortality(P>0.05).By comparingeach group of the IVIG combined glucocorticoids group,the glucocorticoids group,and the IVIG group,we found that the clinical benefits of the IVIG combined glucocorticoids were superior to those of the glucocorticoids alone and IVIG alone,and the treatment of IVIG alone may be worse than the glucocorticoids alone.IVIG combined glucocorticoids is the preferred solution among these three schemes.4.Meta-analysis comparison of the effect of IVIG combined glucocorticoids group and the new treatment regimen TNF-α antagonist group on SMR: Both IVIG combined glucocorticoids treatment and TNF-α antagonist can effectively reduce mortality(all P <0.05);Compared with IVIG combined hormone(RR = 0.54,P <0.05)treatment,TNF-α antagonists(RR = 0.25,P <0.05)have more advantages in reducing mortality.Conclusion1.IVIG combined with hormone can effectively shorten the time to disease progression and hospital stay compared to hormone therapy alone;Regardless of the dose of IVIG in IVIGcombined with hormone therapy,this benefit is significant compared to hormone therapy.2.IVIG alone may be less effective than hormone therapy alone.3.The benefits of IVIG combined with hormone therapy are better than IVIG alone,IVIG combined with hormones significantly reduces mortality compared to IVIG alone;IVIG alone does not improve mortality Effectively.4.From the above conclusions,we can see that the clinical benefit of IVIG combined with hormones is superior to that of hormones and IVIG alone.IVIG alone may be less effective than hormone alone.IVIG combined hormone is the preferred solution among these three schemes.5.IVIG combined with hormone therapy and TNF-α antagonists can effectively reduce mortality.Compared with the preferred IVIG combination hormone therapy,TNF-αantagonists have an advantage in reducing mortality.TNF-α antagonist may be the most promising treatment for SJS / TEN. |
