地塞米松辅助治疗小儿细菌性脑膜炎疗效和安全性的Meta分析  

A Meta-analysis of dexamethasone as adjunctive treatment among children with bacterial meningitis

作　　者：宋颖燕[1] 王亚娟[2] 华琳[3] 王俊霞[1] 

机构地区：[1]北京市仁和医院儿科,102600 [2]首都医科大学附属北京市儿童医院新生儿中心 [3]首都医科大学统计学教研室

出　　处：《中华临床医师杂志（电子版）》2012年第16期4787-4794,共8页Chinese Journal of Clinicians(Electronic Edition)

基　　金：首都医学发展科研基金(2009-2078);北京市卫生系统高层次卫生技术人才培养计划(2009-3-41)

摘　　要：目的系统评价地塞米松辅助治疗小儿急性细菌性脑膜炎的疗效及不良反应。方法检索Cochrane图书馆、PubMed、EMBASE、中国生物医学文献光盘数据库、中国期刊全文数据库和中国维普数据库等关于地塞米松治疗小儿细菌性脑膜炎的疗效和神经系统后遗症的随机对照试验(RCT)文献,检索时间均从1966年1月至2010年2月,由3名系统评价员进行文献资料提取和质量评价。评价指标为地塞米松辅助治疗小儿细菌性脑膜炎的疗效及其不良反应的发病率。采用RevMan4.2软件进行Meta分析。结果共检索到2027篇文献,符合纳入标准的6篇RCT文献(n=770)进入Meta分析。Meta分析结果显示:地塞米松组可缩短入院后的退热天数(SMD=-0.98,95%CI:-1.24～-0.73,P<0.00001),使入院24h脑脊液中的乳酸含量降低(SMD=0.5,95%CI:0.21～0.80,P=0.0007),但对脑脊液中白细胞计数(SMD=0.02,95%CI:-0.39～0.42,P=0.94)、糖含量(SMD=0.71,95%CI:-0.06～1.47,P=0.07)和蛋白含量(SMD=0.27,95%CI:-0.15～0.69,P=0.20)无明显影响;死亡率与安慰剂组比较没有统计学差异(OR=0.61,95%CI:0.33～1.13,P=0.12);听力损害发生率地塞米松组显著低于安慰剂组(OR=0.38,95%CI:0.2～0.72,P=0.003);神经系统后遗症发病率地塞米松组显著低于安慰剂组(OR=0.37,95%CI:0.24～0.57,P<0.00001);反应性关节炎发病率降低(OR=0.21,95%CI:0.05～0.07,P=0.03);应用地塞米松没有增加二次发热的发生率(OR=1.96,95%CI:0.69～5.53,P=0.0007),也没有增加消化道出血的风险(2/102vs.0/99,P=0.3)。结论现有的证据显示,地塞米松治疗小儿细菌性脑膜炎具有一定疗效,使入院后发热天数缩短,降低了入院后24h脑脊液中乳酸浓度,降低了听力损害及神经系统后遗症的发生率,降低反应性关节炎的发病率,但对死亡率及入院24h脑脊液中白细胞计数、糖和蛋白浓度没有明显影响;地塞米松并没有增加二次发热及消化道出血等常见不良反应的风险。Objective To systematically assess the therapeutic and adverse effect of the adjunctive administration of dexamethasone in the treatment of children with acute bacterial meningitis.Methods We performed a systematic review and a Meta-analysis of data from placebo-controlled randomized trails of dexamethasone for acute bacterial meningitis in children by searching several databases for reports(published from January 1966 to February 2010).Evaluation for the adjuvant treatment of dexamethasone efficacy of bacterial meningitis in children,including afebril days,white blood cell count(WBC),glucose,protein and lactic acid changes in cerebrospinal fluid after 24 hours of admission,the incidence of mortality,hearing damage,neurological sequelae and reactive arthritis.Side effects of dexamethasone such as gastrointestinal(GI)bleeding,secondary fever were also evaluated.Meta-analysis software was used RevMan 4.2.Results A total of 2027 articles were retrieved that met the inclusion criteria of the six RCT literature(n=770)into the Meta analysis.Meta analysis showed that dexamethasone can reduce the number of fever days after admission(SMD=-0.98,95% CI:-1.24-0.73,P<0.00001).Patients who received dexamethasone had a significantly larger decreased in lactate concent(SMD=0.5,95% CI:0.21-0.80,P=0.0007)in CSF,but had no effect on WBC(SMD=0.02,95% CI:-0.39-0.42,P=0.94),glucose concentration(SMD=0.71,95% CI:-0.06-1.47,P=0.007)and protein concentration(SMD=0.27,95% CI:-0.15-0.69,P=0.20)in CSF;Mortality compared with the placebo group had no significant difference(OR=0.61,95% CI:0.33-1.13,P=0.12);The incidence of hearing loss in the dexamethasone group was significantly lower than the placebo group(OR=0.38,95% CI:0.2-0.72,P=0.003);Neurological sequelae incidence in the dexamethasone group was significantly lower than the placebo group(OR=0.37,95% CI:0.24-0.57,P<0.00001);The incidence of reactive arthritis was reduced(OR=0.21,95% CI:0.05-0.07,P=0.03)among survivors.The short-term mortality rate associated with dexamethasone administr

关 键 词：地塞米松 儿童 脑膜炎 细菌性 META分析 治疗结果 安全 

分 类 号：R725.1[医药卫生—儿科]