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

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