Salicylate sebagai rawatan penyakit Kawasaki dalam golongan kanak‐kanak
Abstract
Background
Kawasaki disease is the most common cause of acquired heart disease in children in developed countries. The coronary arteries supplying the heart can be damaged in Kawasaki disease. The principal advantage of timely diagnosis is the potential to prevent this complication with early treatment. Salicylate (acetyl salicylate acid (ASA), aspirin) and intravenous immunoglobulin (IVIG) are widely used for this purpose. Salicylate is largely otherwise avoided in children because of concerns about serious side effects, particularly the risk of Reyes syndrome.
Objectives
The objective of this review was to evaluate the effectiveness of salicylate in treating and preventing cardiac consequences of Kawasaki disease in children.
Search methods
For this update the Cochrane Peripheral Vascular Diseases Group searched their trials register (last searched January 2009) and the Cochrane Central Register of Controlled Trials (CENTRAL) (last searched Issue 1, 2009). The authors searched MEDLINE (January 1966 to July 2006), EMBASE (January 1980 to July 2006), and CINAHL (1982 to July 2006), and reference list of articles. In addition, we contacted experts in the field.
Selection criteria
Randomised controlled trials (RCTs) of salicylate to treat Kawasaki disease in children were eligible for inclusion.
Data collection and analysis
Two authors independently assessed trial quality and extracted data. Study authors were contacted for additional information.
Main results
We found one trial involving 102 children which was described as randomised, but it was not possible to confirm the method of treatment allocation. A second comparative study, possibly with a randomised treatment allocation, was also identified. The one randomised trial reported no association between the addition of ASA to IVIG treatment on the rate of coronary artery abnormalities at follow up, but with wide confidence limits. The second, possibly randomised trial did demonstrate a reduction in duration of fever with high dose ASA compared with low dose ASA, but was insufficiently powered to establish the effect on coronary artery abnormalities at follow up.
Authors' conclusions
Until good quality RCTs are carried out, there is insufficient evidence to indicate whether children with Kawasaki disease should continue to receive salicylate as part of their treatment regimen.
PICO
Plain language summary
Salicylate untuk merawat penyakit Kawasaki dalam golongan kanak‐kanak dan untuk mengelakkan ketaknormalan jantung jangka masa panjang.
Penyakit Kawasaki merupakan keradangan saluran darah (vaskulitis) yang terutamanya melibatkan kanak‐kanak muda dibawah umur lima tahun. Ia pertama kali dikenalpasti di kalangan kanak‐kanak di Jepun dan merupakan penyebab terutama penyakit jantung dalam kanak‐kanak di negara‐negara maju. Penyakit Kawasaki boleh menjadi sukar untuk didiagnosis kerana ia mempunyai gejala‐gejala yang serupa dengan banyak jangkitan zaman kanak‐kanak. Komplikasi penyakit Kawasaki yang paling penting disebabkan oleh keradangan arteri koronari (jantung) yang membekalkan darah ke otot jantung. Ini boleh menyebabkan masalah jantung dalam masa terdekat dan kerosakan arteri koronari ini juga boleh mempunyai kesan jangka masa panjang. Salicylate (acetyl salicylate asid, aspirin) dan immunoglobulin intravena (IVIG) digunakan secara meluas untuk merawat penyakit Kawasaki, namun salicylate secara amnya dielakguna di golongan kanak‐kanak kerana kebimbangan tentang kesan‐kesan sampingan yang serius, terutamanya risiko sindrom Reye yang menyebabkan kebengkakan organ otak dan hati.
Para penulis ulasan hanya telah mengenal pasti satu kajian terkawal rawak, dari Jepun yang dilaporkan pada tahun 1991. Sejumlah 102 kanak‐kanak telah dirawakkan untuk menerima IVIG dengan atau tanpa salicylate. Tiada manfaat yang jelas tentang penambahan salicylate atas rawatan immunoglobulin terhadap kadar ketaknormalan arteri koronari yang diperhatikan sehingga 30 hari. Penemuan kajian terbentang luas dan mungkin melingkupi kesan baik salicylate. Dari segi teori, terdapat kemanfaatan dalam penggunaan salicylate untuk mencegah kerosakan arteri koronari. Walau bagaimanapun, terdapat kebimbangan mengenai penggunaan aspirin untuk merawat gejala demam di golongan kanak‐kanak; iaitu ia boleh membawa kesan sampingan; dan kanak‐kanak yang menghidapi penyakit Kawasaki yang dirawat dengan immunoglobulins sememangnya mempunyai kadar ketaknormalan arteri koronari yang sangat rendah.
