吸入性糖皮质激素预防早产儿慢性肺疾病有效性和安全性的meta分析

发布时间：2018-10-20 18:50

【摘要】：目的系统评价吸入性糖皮质激素预防早产儿慢性肺疾病(CLD)的有效性和安全性。方法计算机检索Pub Med、EMBASE、CENTRAL、the ISI Web of Knowledge Databases、CBM、CNKI和VIP、Wan Fang Data,检索时限均为建库至2016年10月,搜集所有研究吸入性糖皮质激素防治早产儿CLD的疗效和安全性的随机对照试验(RCT),并进行RCT的筛选、资料提取和质量评价,应用Rev Man 5.3软件进行meta分析。结果共纳入12篇RCT,2 051例早产儿。与对照组比较,28天组吸入糖皮质激素组,以及吸入布地奈德亚组、倍氯米松亚组和氟替卡松亚组,CLD发生率的差异无统计学意义(P均0.05)。与对照组比较,校正胎龄36周组吸入糖皮质激素组(RR=0.70,95%CI:0.61~0.80)、雾化吸入亚组(RR=0.74,95%CI:0.63~0.87)、气管内给药亚组(RR=0.57,95%CI:0.43~0.76)以及布地奈德亚组(RR=0.67;95%CI:0.57~0.78)和氟替卡松亚组(RR=0.58,95%CI:0.36~0.94),CLD发生率的差异有统计学意义(P均0.05);而倍氯米松组CLD发生率与对照组差异无统计学意义(P=0.90);总的病死率差异无统计学意义(P=0.55);雾化吸入亚组和气管内给药亚组以及布地奈德亚组、倍氯米松亚组和氟替卡松亚组病死率与对照组比较差异无统计学意义(P均0.05)。结论预防性使用吸入性糖皮质激素能有效降低早产儿CLD的发病率,但对病死率无影响,与给药方式和给药类型无显著相关性。同时推荐以校正胎龄36周为结局指标观察点,但相关研究数量有限,且缺乏长期随访结果,因此吸入性糖皮质激素的作用及远期并发症,仍需大量的临床研究来评估,建议临床谨慎使用。
[Abstract]:Objective to evaluate the efficacy and safety of inhaled glucocorticoid in the prevention of (CLD) in premature infants with chronic lung disease. Methods both Pub Med,EMBASE,CENTRAL,the ISI Web of Knowledge Databases,CBM,CNKI and VIP,Wan Fang Data, were searched by computer until October 2016. All randomized controlled trials (RCT),) to study the efficacy and safety of inhaled glucocorticoid in preventing and treating CLD in premature infants were collected and RCT screening was performed. Data extraction and quality evaluation, meta analysis using Rev Man 5.3 software. Results A total of 12 RCT,2 cases were included in this study. Compared with the control group, there was no significant difference in the incidence of CLD in the 28 day inhaled glucocorticoid group, the inhaled budesonide subgroup, beclomethasone subgroup and fluticasone subgroup (P0. 05). Compared with the control group, The incidence of corticosteroid inhalation (RR=0.70,95%CI:0.61~0.80), nebulized inhaled subgroup (RR=0.74,95%CI:0.63~0.87), intratracheal administration subgroup (RR=0.57,95%CI:0.43~0.76), budesonide subgroup (RR=0.67;95%CI:0.57~0.78) and fluticasone subgroup (RR=0.58,95%CI:0.36~0.94), CLD) in 36 weeks of corrected gestational age group were significantly different, whereas the incidence of CLD in beclomethasone group was significantly higher than that in beclomethasone group (P < 0. 05). There was no significant difference between the incidence rate and the control group (P < 0.90), there was no significant difference in the overall mortality rate (P < 0.55), the nebulization subgroup, the intratracheal administration subgroup and the budesonide subgroup were not significantly different from those in the control group. There was no significant difference in mortality between betamethasone subgroup and fluticasone subgroup (P 0.05). Conclusion prophylactic use of inhaled glucocorticoids can effectively reduce the incidence of CLD in premature infants, but has no effect on the mortality, and has no significant correlation with the administration mode and type of administration. At the same time, 36 weeks of corrected gestational age is recommended as the observation point of outcome, but the number of related studies is limited and there is no long-term follow-up results. Therefore, the role of inhaled glucocorticoids and long-term complications still need a large number of clinical studies to evaluate. Clinical caution is recommended.
【作者单位】：西南医科大学附属医院新生儿科;
【分类号】：R722.6

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