地塞米松治疗或预防早产儿慢性肺疾病远期预后的Meta分析  

Long-term effects of postnatal dexamethasone administration in prevention or treatment of chronic lung disease in preterm infants： a Meta-analysis

作　　者：全美盈[1] 李正红[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院儿科,100730

出　　处：《中华全科医师杂志》2013年第8期616-621,共6页Chinese Journal of General Practitioners

摘　　要：目的系统评价早产儿生后应用地塞米松预防或治疗慢性肺疾病（CLD）的远期预后。方法制定文献的纳入排除标准及检索策略，检索Medline、Embase数据库、Cochrane图书馆及中国生物医学期刊引文数据库、中国期刊全文数据库、中国维普数据库、万方数据库；手工检索近年国际国内儿科会议文集，获得有关早产儿应用地塞米松预防或治疗CLD的远期预后（随访时间≥2年）的随机对照实验（RCT）文献。应用RevMan5．0软件对早产儿应用地塞米松预防和治疗CLD的远期预后如神经系统预后、呼吸系统预后及死亡率等进行Meta分析。结果共纳入8个RCT（共13篇文献）进入Meta分析。数据合并分析结果显示，应用地塞米松组儿童期反复呼吸系统疾病发生率从49．7％降至38．9％，RR=0．57（95％CI：0．37～0．88，P〈0．05）。神经系统发育的远期预后方面，地塞米松组患儿脑瘫的发生率明显升高，RR=1．95（95％CI：1．41～2．71，P〈0．01）；依据地塞米松的应用时间进行分层分析发现，早期（生后1周内）应用地塞米松组脑瘫发生率较对照组明显升高，RR=2．59（95％CI：1．59—4．21，P〈0．叭），而晚期（出生1周以后）应用地塞米松组脑瘫发生率与对照组差异无统计学意义，RR=1．5（95％CI：0．95～2．36，P=0．08）；智力落后（RR=0．77，95％CI：0．28～0．14，P〉0．05）、耳聋（RR=0．52，95％c，：0．17～1．56，P：0．24）及严重视力障碍（RR=1．56，95％CI：0．77～3．18，P=0．22）的发生率在地塞米松组及对照组间差异无统计学意义。两组的死亡率差异无统计学意义，RR=0．91（95％CI：0．71～1．16，P〉0．05）。结论生后静脉应用地塞米松预防或治疗CLD的早产儿儿童期反复呼吸系统疾病的发生率降低；脑瘫的发生率明显增高，但多发生于早期应用地塞米松的早产儿，出生后晚期�Objective To evaluate the long-term effects of postnatal dexamethasone administration in prevention or treatment of chronic lung disease （ CLD ） in preterm infants. Methods All randomized controlled clinical trials （RCT） on long-term effect of postnatal dexamethasone in prevention or treatment of chronic lung disease in preterm infants were searched in Medline, Embase database, Cochrane Library and Chinese Medical Citation Index database, China National Knowledge infrastructure, VIP Chinese Periodical Database and Chinese Digital Hospital Library and Wanfang Chinese periodical database. As a supplementation, the works of domestic and international pediatric conferences were collected by manual search. The follow-up time was defined as longer than two years. Revman 5.0 was used for Meta-analysis for the effects of dexamethasone on nervous system, respiratory system and mortality. Results Eight RCTs fulfilled the including criteria. Statistical analysis revealed that the incidence of recurrent respiratory disease decreased from 49. 7% to 38.9% in the dexamethasone group compared to the control group with RR = 0. 57 （95% CI：O. 37-0. 88,P 〈 0. 05 ）. But the incidence of cerebral palsy in dexamethasone group increased significantly （RR = 1.95, 95% CI： 1.41 -2.71, P 〈 0. 01 ）. Stratified analysis revealed that the incidence of cerebral palsy in early-use group （within 1 week after birth） was higher than that in control group （RR = 2. 59,95% CI： 1.59 -4. 21, P 〈0. 01 ） ; while the incidence in later-use group （ 1 week after birth） was not statistically different from that in control group （RR = 1.5, 95% CI： 0. 95 -2. 36, P = 0. 08）. There were no significant differences in the incidence of mental retardation （ RR = 0. 77, 95% CI： 0. 28 - 0. 14, P 〉 0. 05） , deafness （RR =0. 52,95% CI： O. 17 - 1.56, P =0. 24） and severe visual impairment （RR = 1.56, 95% CI： O. 77- 3.18, P = 0. 22 ） between dexamethasone group and control group, as well as in mortality rate

关 键 词：地塞米松 婴儿 早产 肺疾病 

分 类 号：R722.6[医药卫生—儿科]