Effect of gamma-globulin in adult patients with myocarditis: a meta-analysis

doi:10.3877/cma.j.issn.1674-6880.2019.06.007

Abstract

Abstract:

Objective

To systematically evaluate the effect of gamma-globulin in adult patients with myocarditis.

Methods

The randomized controlled trials about gamma-globulin for the treatment of adult myocarditis patients were retrieved from the CNKI, Wanfang and PubMed databases published up to March 2019. Two reviewers independently screened articles, extracted data and evaluated the quality of included studies. Then meta-analysis was performed using the Review Manager 5.2.

Results

A total of 27 articles with 2 272 patients were included in this study, 1 067 patients in the experimental group and 1 205 in the control group. Meta-analysis demonstrated that as compared with the control group, the clinical efficacy was better [odds ratio (OR) = 4.88, 95% confidence interval (CI) (3.38, 7.05), Z = 8.45, P<0.001], and the left ventricular ejection fraction (LVEF) was higher [mean differences (MD) = 0.07, 95%CI (0.05, 0.09), Z = 6.97, P < 0.001], and the left ventricular end diastolic diameter (LVDD) [MD = -0.19, 95% CI (-0.22, -0.15), Z = 10.86, P<0.001], creatine kinase isoenzyme MB (CK-MB) [MD=-10.72, 95%CI (-13.03, -8.40), Z = 9.07, P < 0.001] and brain natriuretic peptide (BNP) [MD = -173.32, 95%CI (-230.22, -116.43), Z = 6.97, P < 0.001] were lower in the experimental group. However, the cardiac troponin T [MD = -0.47, 95% CI (-1.05, 0.11), Z = 1.58, P = 0.11] and in-hospital mortality [OR = 0.59, 95% CI (0.08, 4.22), Z = 0.52, P = 0.60] were not significantly different between the two groups.

Conclusion

Gamma-globulin can obviously improve the clinical efficacy, increase LVEF and reduce LVDD, CK-MB and BNP in adult patients with myocarditis, but it does not affect their troponin T and in-hospital mortality.

Key words: Gamma-globulins, Myocarditis, Meta-analysis

Sichi Xu, Jie Yan, Zhouyan Bian, Xiaoyang Zhou, Qizhu Tang. Effect of gamma-globulin in adult patients with myocarditis: a meta-analysis[J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2019, 12(06): 393-401.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhwzzyxzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-6880.2019.06.007

https://zhwzzyxzz.cma-cmc.com.cn/EN/Y2019/V12/I06/393

Figures/Tables 8

References 51

1	Blyszczuk P. Myocarditis in humans and in experimental animal models[J]. Front Cardiovasc Med, 2019 (6): 64.
2	Hékimian G, Combes A. Myocarditis[J]. Rev Med Interne, 2017, 38 (8): 531-538.
3	Yang L, Wu EY, Tarrant TK. Immune gamma globulin therapeutic indications in immune deficiency and autoimmunity[J]. Curr Allergy Asthma Rep, 2016, 16 (8): 55.
4	Mohammadzadeh I, Noei S, Babazadeh K, et al. Comparison of early and late intravenous gamma globulin treatment of Kawasaki disease on fever and cardio-vascular complications[J]. Caspian J Intern Med, 2016, 7 (3): 211-216.
5	Canter CE. Therapy for pediatric myocarditis[J]. Curr Treat Options Cardiovasc Med, 2005, 7 (5): 411-417.
6	Heymans S, Eriksson U, Lehtonen J, et al. The quest for new approaches in myocarditis and inflammatory cardiomyopathy[J]. J Am Coll Cardiol, 2016, 68 (21): 2348-2364.
7	中华医学会心血管病学分会精准医学学组，中华心血管病杂志编辑委员会，成人暴发性心肌炎工作组.成人暴发性心肌炎诊断与治疗中国专家共识[J].中华心血管病杂志，2017，45(9):742-752.
8	丁健. 27例病毒性心肌炎临床治疗分析[J].中外医学研究，2013，11(21):170.
9	唐玉立. 66例病毒性心肌炎患者的临床治疗[J].中国药物经济学，2014(5):244-245.
10	庞秀梅.丙种球蛋白对成人重症心肌炎的疗效及对预后的影响[J/CD].中西医结合心血管病电子杂志，2016，4(2):26-27.
11	郭伟民，韩俊兴.丙种球蛋白对成人重症心肌炎的治疗效果探讨[J].基层医学论坛，2016，20(35):4980-4981.
12	王平.丙种球蛋白辅助治疗心肌炎合并房室传导阻滞的疗效探讨[J].心理医生，2017，23(35):158-159.
13	覃露海，蒙恩绩，兰枝东.丙种球蛋白辅助治疗心肌炎合并房室传导阻滞的效果[J].实用临床医药杂志，2017，21(7):162-163.
14	郝翠芹，张恩成，刘珠存，等.丙种球蛋白通过静脉滴注对于病毒性心肌炎的临床疗效分析[J].大家健康，2012，6(7):27-28.
15	贺文强.丙种球蛋白治疗成人重症心肌炎的临床分析[J].中国医药指南，2015，13(24):107-108.
16	余海波.丙种球蛋白治疗成人重症心肌炎的临床观察[J].医药前沿，2014，32(29):196.
17	任琳琳.丙种球蛋白治疗成人重症心肌炎的临床观察[J/CD].中西医结合心血管病电子杂志，2016，4(13):66-67.
18	孙明月，马晓静.丙种球蛋白治疗成人重症心肌炎的临床观察[J].医学与哲学，2011，32(7):29-30,41.
19	李延召.丙种球蛋白治疗重症心肌炎的疗效及对心肌损伤指标的影响[J].中外医疗，2016，35(19):120-122.
20	陈孟青.丙种球蛋白治疗重症心肌炎的临床疗效及对心肌损伤指标的影响[J].医药前沿，2017，7(9):43-45.
21	郑炜华.丙种球蛋白治疗重症心肌炎的临床疗效及对心肌损伤指标的影响[J].实用心脑肺血管病杂志，2015，23(5):56-58.
22	梁美华.丙种球蛋白治疗重症心肌炎的临床疗效及对心肌损伤指标的影响研究[J].医药前沿，2017，7(7):70-71.
23	高飞，赵惠娟，毕展建，等.丙种球蛋白治疗重症心肌炎的临床效果研究[J].医学信息，2015，28(49):335.
24	张秀华.病毒性心肌炎的临床治疗效果分析[J].中国医药指南，2014，12(18):219-220.
25	黄锦浪，罗永军.大剂量丙种球蛋白治疗中、重度病毒性心肌炎的效果分析[J].中国医药科学，2016，6(20):157-159.
26	陈心涛，张帆.观察丙种球蛋白对成人重症心肌炎的治疗效果[J].临床研究，2016，24(8):147-148.
27	张广成，曹文勇.急性重症心肌炎临床疗效探讨[J].中外医疗，2015，34(35):88-89.
28	王罡.探讨丙种球蛋白治疗重症心肌炎的临床疗效[J].临床研究，2016，24(6):40.
29	牟斌.用丙种球蛋白治疗重症心肌炎的效果及对患者心功能的影响[J].当代医药论丛，2018，16(8):87-88.
30	王念龙.重症心肌炎患者经丙种球蛋白治疗的临床效果对其cTnT、CK-MB、BNP水平的影响[J].医药前沿，2018，8(16):49-50.
31	郭宏，王安杏，孙牧，等.重症心肌炎患者经丙种球蛋白治疗的临床效果对其cTnT、CK-MB、BNP水平的影响[J].中国医药导报，2016，13(22):61-64,68.
32	朱德才，麦一峰，马龙洲，等.重症心肌炎患者治疗中丙种球蛋白对心肌损伤与心功能及血清免疫学指标的影响分析[J].中华医院感染学杂志，2016，26(24):5601-5603.
33	Yu DQ, Wang Y, Ma GZ, et al. Intravenous immu-noglobulin in the therapy of adult acute fulminant myocarditis: a retrospective study[J]. Exp Ther Med, 2014, 7 (1): 97-102.
34	Isogai T, Yasunaga H, Matsui H, et al. Effect of intravenous immunoglobulin for fulminant myocarditis on in-hospital mortality: propensity score analyses[J]. J Card Fail, 2015, 21 (5): 391-397.
35	Caforio AL, Tona F, Bottaro S, et al. Clinical implications of anti-heart autoantibodies in myocarditis and dilated cardiomyopathy[J]. Autoimmunity, 2008, 41 (1): 35-45.
36	Becker NP, Müller J, Gottel P, et al. Cardiomyopathy-an approach to the autoimmune background[J]. Autoimmun Rev, 2017, 16 (3): 269-286.
37	Moiseeva OM, Mitrofanova LB, Nakatseva EV, et al. Comparative analysis of the serum level of autoantibodies as a diagnostic tool of myocardial in-flammatory diseases[J]. Ter Arkh, 2012, 84 (9): 47-52.
38	Aranda-Uribe IS, Ortega E, Martínez-Cordero E. Immunization of BALB/c mice with pigeon IgY induces the production of anti-IgG autoantibodies[J]. Autoimmunity, 2017, 50 (6): 336-345.
39	Kishimoto C, Shioji K, Kinoshita M, et al. Treatment of acute inflammatory cardiomyopathy with intravenous immunoglobulin ameliorates left ventricular function associated with suppression of inflammatory cytokines and decreased oxidative stress[J]. Int J Cardiol, 2003, 91 (2): 173-178.
40	卿琪，罗燕，严山珊，等.静脉注射免疫球蛋白辅助治疗严重脓毒症患者有效性的Meta分析[J].中华危重病急救医学，2016，28(5):407-412.
41	Maisch B. Cardio-immunology of myocarditis: focus on immune mechanisms and treatment options[J]. Front Cardiovasc Med, 2019 (6): 48.
42	Chaigne B, Mouthon L. Mechanisms of action of intravenous immunoglobulin[J]. Transfus Apher Sci, 2017, 56 (1): 45-49.
43	Hu YF, Gong FQ, Chen LQ, et al. Effect of in-travenous immunoglobulin and vitamin C on progression of experimental autoimmune myocarditis in mice[J]. Zhejiang Da Xue Xue Bao Yi Xue Ban, 2008, 7 (4): 399-406.
44	Robinson JL, Hartling L, Crumley E, et al. A systematic review of intravenous gamma globulin for therapy of acute myocarditis[J]. BMC Cardiovasc Disord, 2005, 5 (1): 12.
45	Orange JS, Hossny EM, Weiler CR, et al. Use of intravenous immunoglobulin in human disease: a review of evidence by members of the Primary Imm-unodeficiency Committee of the American Academy of Allergy, Asthma and Immunology[J]. J Allergy Clin Immunol, 2006, 117 (4 Suppl): S525-S553.
46	Kim HS, Sohn S, Park JY, et al. Fulminant my-ocarditis successfully treated with high-dose immun-oglobulin[J]. Int J Cardiol, 2004, 96 (3): 485-486.
47	Tsai YG, Ou TY, Wang CC, et al. Intravenous gamma-globulin therapy in myocarditis complicated with complete heart block: report of one case[J]. Acta Paediatr Taiwan, 2001, 42 (5): 311-313.
48	Kishimoto C, Shioji K, Kinoshita M, et al. Treatment of acute inflammatory cardiomyopathy with intravenous immunoglobulin ameliorates left ventricular function associated with suppression of inflammatory cytokines and decreased oxidative stress[J]. Int J Cardiol, 2003, 91 (2-3): 173-178.
49	McNamara DM, Rosenblum WD, Janosko KM, et al. Intravenous immune globulin in the therapy of myocarditis and acute cardiomyopathy[J]. Circulation, 1997, 95 (11): 2476-2478.
50	洪军，孙仁华，屈百鸣，等.经皮心肺辅助循环治疗重症心肌炎合并心源性休克七例[J/CD].中华危重症医学杂志（电子版），2013，6(1):36-38.
51	Kato S, Morimoto S, Hiramitsu S, et al. Successful high-dose intravenous immunoglobulin therapy for a patient with fulminant myocarditis[J]. Heart Vessels, 2007, 22 (1): 48-51.

纳入研究	样本量（例）		年龄[岁，±s或M（P₂₅，P₇₅）或范围]		病程（范围或±s）		临床表现	质量级别
纳入研究	实验组	对照组	实验组	对照组	实验组	对照组	临床表现	质量级别
丁健^[8]2013	27	25	40.5	43.5	10 d ~ 3.7年	15 d ~ 14年	①②③④	低
唐玉立^[9]2014	37	29	39.7（20，58）	42.4（22，60）	1~3年	1~4年	①③④	低
庞秀梅^[10]2016	47	47	38.86 ± 2.91	38.27 ± 2.16	-	-	②③	高
郭伟民等^[11]2016	30	30	35.8 ± 6.2		-	-	①②⑤	低
王平^[12]2017	23	23	43.24 ± 6.85		-	-	-	低
覃露海等^[13]2017	28	27	31.19 ± 9.89	28.11 ± 9.54	-	-	⑤	低
郝翠芹等^[14]2012	60	60	35 ± 2		-	-	①②③④⑤⑥	低
贺文强^[15]2015	11	9	17 ~ 51	16 ~ 50	-	-	①②③④⑥	低
余海波^[16]2014	15	15	35.4 ± 1.9	34.1 ± 1.6	-	-	-	低
任琳琳^[17]2016	41	41	33.9 ± 5.7	33.4 ± 5.6	-	-	-	低
孙明月等^[18]2011	18	15	32.6 ± 10.6	31.0 ± 10.1	急性		①②③④⑤⑥	低
李延召^[19]2016	30	30	32.7 ± 4.3	33.1 ± 3.8	-	-	-	低
陈孟青^[20]2017	20	20	33.9 ± 4.5	32.1 ± 2.5	-	-	-	低
郑炜华^[21]2015	35	35	31.7 ± 4.1	31.9 ± 4.3	-	-	-	低
梁美华^[22]2017	55	55	36 ± 15.68	37 ± 15.46	-	-	-	低
高飞等^[23]2015	18	15	32.6 ± 10.6	31.0 ± 10.1	急性		-	低
张秀华^[24]2014	32	32	42 ± 1.2		1.2 d ~ 2.8年		②③④	高
黄锦浪等^[25]2016	30	30	28.5 ± 3.2	28.20 ± 3.4	（5.8 ± 2.1）d	（5.6 ± 1.8）d	①⑥⑦	高
陈心涛等^[26]2016	50	50	43.9 ± 2.3	-	-	-	-	低
张广成等^[27]2015	40	40	42.8 ± 2.13	43.5 ± 1.01	急性		-	低
王罡^[28]2016	50	50	34.38 ± 2.7	35.5 ± 2.2	-	-	-	高
牟斌^[29]2018	26	26	34.18 ± 3.36	32.65 ± 3.17	（3.02 ± 0.75）年	（3.01 ± 0.86）年	⑤	低
王念龙^[30]2018	36	36	32.58 ± 5.76	33.74 ± 5.91	（9.47 ± 1.65）年	（9.22 ± 1.63）年	⑦⑧	低
郭宏等^[31]2016	20	20	32.24 ± 5.48	31.79 ± 4.87	（9.16 ± 1.27）年	（9.12 ± 1.04）年	②③④⑤⑥⑦⑧	高
朱德才等^[32]2016	36	36	31.3 ± 4.7	31.0 ± 4.2	（9.6 ± 1.4）d	（9.5 ± 1.8）d	-	高
Yu等^[33]2014	32	26	30.6 ± 14.1	30.0 ± 16.6	< 3个月		⑥⑦⑧	低
Isogai等^[34]2015	164	164	16 ~ 70		-	-	-	低

纳入研究	样本量（例）		年龄[岁，±s或M（P₂₅，P₇₅）或范围]		病程（范围或±s）		临床表现	质量级别
纳入研究	实验组	对照组	实验组	对照组	实验组	对照组	临床表现	质量级别
丁健^[8]2013	27	25	40.5	43.5	10 d ~ 3.7年	15 d ~ 14年	①②③④	低
唐玉立^[9]2014	37	29	39.7（20，58）	42.4（22，60）	1~3年	1~4年	①③④	低
庞秀梅^[10]2016	47	47	38.86 ± 2.91	38.27 ± 2.16	-	-	②③	高
郭伟民等^[11]2016	30	30	35.8 ± 6.2		-	-	①②⑤	低
王平^[12]2017	23	23	43.24 ± 6.85		-	-	-	低
覃露海等^[13]2017	28	27	31.19 ± 9.89	28.11 ± 9.54	-	-	⑤	低
郝翠芹等^[14]2012	60	60	35 ± 2		-	-	①②③④⑤⑥	低
贺文强^[15]2015	11	9	17 ~ 51	16 ~ 50	-	-	①②③④⑥	低
余海波^[16]2014	15	15	35.4 ± 1.9	34.1 ± 1.6	-	-	-	低
任琳琳^[17]2016	41	41	33.9 ± 5.7	33.4 ± 5.6	-	-	-	低
孙明月等^[18]2011	18	15	32.6 ± 10.6	31.0 ± 10.1	急性		①②③④⑤⑥	低
李延召^[19]2016	30	30	32.7 ± 4.3	33.1 ± 3.8	-	-	-	低
陈孟青^[20]2017	20	20	33.9 ± 4.5	32.1 ± 2.5	-	-	-	低
郑炜华^[21]2015	35	35	31.7 ± 4.1	31.9 ± 4.3	-	-	-	低
梁美华^[22]2017	55	55	36 ± 15.68	37 ± 15.46	-	-	-	低
高飞等^[23]2015	18	15	32.6 ± 10.6	31.0 ± 10.1	急性		-	低
张秀华^[24]2014	32	32	42 ± 1.2		1.2 d ~ 2.8年		②③④	高
黄锦浪等^[25]2016	30	30	28.5 ± 3.2	28.20 ± 3.4	（5.8 ± 2.1）d	（5.6 ± 1.8）d	①⑥⑦	高
陈心涛等^[26]2016	50	50	43.9 ± 2.3	-	-	-	-	低
张广成等^[27]2015	40	40	42.8 ± 2.13	43.5 ± 1.01	急性		-	低
王罡^[28]2016	50	50	34.38 ± 2.7	35.5 ± 2.2	-	-	-	高
牟斌^[29]2018	26	26	34.18 ± 3.36	32.65 ± 3.17	（3.02 ± 0.75）年	（3.01 ± 0.86）年	⑤	低
王念龙^[30]2018	36	36	32.58 ± 5.76	33.74 ± 5.91	（9.47 ± 1.65）年	（9.22 ± 1.63）年	⑦⑧	低
郭宏等^[31]2016	20	20	32.24 ± 5.48	31.79 ± 4.87	（9.16 ± 1.27）年	（9.12 ± 1.04）年	②③④⑤⑥⑦⑧	高
朱德才等^[32]2016	36	36	31.3 ± 4.7	31.0 ± 4.2	（9.6 ± 1.4）d	（9.5 ± 1.8）d	-	高
Yu等^[33]2014	32	26	30.6 ± 14.1	30.0 ± 16.6	< 3个月		⑥⑦⑧	低
Isogai等^[34]2015	164	164	16 ~ 70		-	-	-	低

[1]	Siping Zhang, Wei Liu, Pengcheng Ma. Therapeutic effects of lower extremity mild varus alignment after total knee arthroplasty [J]. Chinese Journal of Joint Surgery(Electronic Edition), 2023, 17(06): 808-817.
[2]	Wanglin Luo, Chuanjun Yang, Guoxing Xu, Jianguo Yu, Weidong Sun, Wenjuan Yan, Zhi Feng. Meta analysis on implantation of different grafting materials in open wedge high tibial osteotomy [J]. Chinese Journal of Joint Surgery(Electronic Edition), 2023, 17(06): 818-826.
[3]	Hongxing Chen, Lijun Zhang, Yong Zhang, Hu Li, Chi Zhou, Yinuo Fan. Meta-analysis of effect of external application of traditional Chinese medicine after arthroscopic debridement in knee osteoarthritis [J]. Chinese Journal of Joint Surgery(Electronic Edition), 2023, 17(05): 663-672.
[4]	Yang Xing, Aishan He, Yan Kang, Zibo Yang, Fangang Meng, Peihui Wu. Meta-analysis of single-bundle reconstruction combining anterolateral reconstruction of anterior cruciate ligament [J]. Chinese Journal of Joint Surgery(Electronic Edition), 2023, 17(04): 508-519.
[5]	Wei Yang, Xia Hao, Dongzhen Zhu, Jinbo Zhang, Xuefei Tian, Bin Yao. A meta analysis of the clinical effect of traditional Chinese medicine on burn and scald patients [J]. Chinese Journal of Injury Repair and Wound Healing(Electronic Edition), 2023, 18(05): 419-426.
[6]	Xiongxiong Li, Chan Zhou, Ting Xu, Yu Ren, Jin Shang. Metastasis rate of newly diagnosed ductal carcinoma in situ with microinvasive axillary lymph nodes: A Meta-analysis [J]. Chinese Archives of General Surgery(Electronic Edition), 2023, 17(06): 466-474.
[7]	Zaibo Zhang, Bingyu Wang, Zhikai Jiao, Bibo Tan. Risk factors for lower extremity deep venous thrombosis after gastric cancer surgery: A Meta-analysis [J]. Chinese Archives of General Surgery(Electronic Edition), 2023, 17(06): 475-480.
[8]	Huiming Wu, Renkai Guo, Huiyu Li. Safety and efficacy of robot-assisted natural orifice specimen extraction surgery for colorectal cancer: A meta-analysis [J]. Chinese Archives of General Surgery(Electronic Edition), 2023, 17(05): 395-400.
[9]	Xian Mo, Chuang Yang. Meta-analysis of risk factors for portal vein thrombosis in patients with cirrhosis [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2023, 17(06): 678-683.
[10]	Wenzhong Duan, Yanxia Bai, Wenting Xu, Hongxia Qi, Zhijian Lyu. Anesthetic effects of sevoflurane and propofol in hepatectomy: a Meta-analysis [J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2023, 12(06): 640-645.
[11]	Hailong Yang, Manjun Deng, Yichen Fan, Mengyu Xu, Fangde Chen, Weihao Wu, Shengyuan Zhang. Risk factors of bile leakage after primary suture of laparoscopic common bile duct exploration: a Meta-analysis [J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2023, 12(05): 545-550.
[12]	Tuerdehan Ayibieke·, Lunjian Chen, Kalifu Baheti·, Xiong Chen, Yuan Meng. Value of serum immune antigens in the diagnosis of hydatid disease: a Meta-analysis [J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2023, 12(03): 300-304.
[13]	Hongli Xu, Yulin Yang, Qing Xue, Qian Zhang, Lihong Ma, Zhengang Qiu. Efficacy of extracorporeal shock wave for non-specific low back pain: a systematic review and Meta-analysis [J]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2023, 09(05): 307-314.
[14]	Xiu Wang, Yiguo Wang. Efficacy and safety of ustekinumab in treating perianal fistulizing Crohn′s disease: a meta-analysis [J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2023, 13(06): 514-519.
[15]	Huiyuan Su, Hongtao Song, Wei Gao, Zhong Wu. Acupuncture for treatment of simple obesity: systematic review and Meta-analysis [J]. Chinese Journal of Acupuncture and Moxibustion(Electronic Edition), 2023, 12(03): 123-128.

Please choose a citation manager

Content to export