静脉滴注免疫球蛋白与激素对比治疗格林-巴利综合征的meta分析  

Meta analysis on corticosteroids and intravenous immunoglobulin in the treatment of guillain--barre syndrome

作　　者：刘振宝[1] 李建萍[1] 苗玲[1] 

机构地区：[1]上海交通大学医学院附属仁济医院神经内科,200001

出　　处：《神经疾病与精神卫生》2009年第1期26-29,共4页Journal of Neuroscience and Mental Health

摘　　要：目的比较静脉注射大剂量免疫球蛋白（IVIG）与激素治疗格林-巴利综合征（GBS）患者疗效及安全性。方法对国内有关包括IVIG与激素治疗GBS随机对照试验进行meta分析，评价纳入文献的方法学质量后，采用RevMan4．2．10软件对提取的数据进行分析。结果共纳入10个随机对照试验（RCTs）研究，IVIG组共计384例，激素组441例：（1）IVIG与激素治疗GBS的有效率合并检验分析，结果为Z=5．41，P〈0．00001，0R=4．48，95％可信区间（CI）为（2．60，7．72）；（2）IVIG与激素治疗GBS的治愈率合并检验分析结果Z=8．40，P〈0．00001，OR=4．56，95％CI（3．20，6．50）；（3）IVIG与激素治疗GBS的起效时间比较，评价研究发现存在异质性，采用随机效应模型进行综合检验，结果为：Z=17．47，P〈0．00001，WMD=-4．0，95％CI（-4．45，-3．55）。结论IVIG治疗GBS总有效率、治愈率明显优于激素，起效快，在条件允许的情况下，应尽早应用IVIG进行治疗。但IVIG价格昂贵，面对那些不能负担昂贵治疗费用或不能耐受IVIG的患者，激素仍是一个有价值的治疗选择；目前国内IVIG与激素治疗GBS这一领域仍缺乏设计严谨、方法科学的临床研究。Objective To compare the clinical efficacy and safety of large dose of intravenous immunoglobulin （IVIG） and corticosteroids on Guillain--Barre Syndrome （GBS）. Methods A meta analysis about random control studies related to corticosteroids and intravenous immunoglobulin in the treatment of GBS was conducted. After evaluating the methodology quality of the internalized literatures, the valid data was analyzed in RevMan 4. 2. 10. Results 384 cases were included in the IVIG group, and 441 cases were included in the corticosteroids group. An analysis on combined test in the clinical efficacy was conducted between the two goups, the results were Z=5.41, P 〈 0. 00001, OR = 4.48, and 95% CI = 2. 60 - 7. 72. The results of analysis on combined test in the cure rate were Z = 8. 40, P〈 0.00 001, OR=4.56, and 95% CI =3.20-6.50. Throught the comparison in the onset time between IVIG and corticosteroids in the treatment of GBS, evaluation and study found that there was difference. The integrated test was conducted using the random--effect model, and the results were Z= 17.47, P 0.00001,WMD=-4.0, and95% CI=-4.45, -3.55. Conclusions The treatment of IVIG on GBS is safe, the onset time is shorter, and the efficacy rate and the recovery rate of IVIG are superior to cortico- steroids. IVIG should be used as soon as possible, but the cost of IVIG is high. For the patients who can not afford or can not be tolerated with IVIG, corticosteroids is still a valuable treatment option. At present, for IVIG and corticosteroids in the treatment of GBS, there is still a lack of clinical research with rigorous design and scientific methods in China.

关 键 词：免疫球蛋白 激素 格林-巴利综合征 META分析 

分 类 号：R745.43[医药卫生—神经病学与精神病学] R195.1[医药卫生—临床医学]