糖皮质激素对成人社区获得性肺炎的辅助治疗价值系统评价

发布时间：2018-07-26 09:16

【摘要】：目的:社区获得性肺炎是通过社区途径获得的感染,而不是指住院期间罹患的肺炎,是引起疾病和死亡的重要原因。本系统评价旨在明确糖皮质激素对成人社区获得性肺炎的辅助治疗的有效性和安全性。方法:通过全面系统的检索,获取已经发表的关于糖皮质激素治疗成人社区获得性肺炎的随机对照临床试验进行系统评价。计算机检索Pubmed,EMBASE,Cochrane图书馆,Ovid数据库,Elisevier,中国生物医学文献数据库、中国学术期刊全文数据库、万方医学数据库、中国知网(CNKI)、维普中文科技期刊数据库。检索时间截至2015年12月。检索词为社区获得性肺炎、皮质激素、糖皮质激素、地塞米松、氢化可的松、泼尼松、甲基泼尼松龙。最终纳入13项随机对照临床试验。采用Cochrane偏倚风险评估工具对所筛选文献进行质量评估,分析采用Cochrane系统评价软件Rev Man 5.3。对于可以合并分析的指标进行Meta分析。Meta分析中研究结果是二分类变量采用比值比(OR)及其95%可信区间(confidence interval,CI),连续性变量则采用均数差(mean difference,MD)及其95%CI。对无统计学异质性的研究,用固定效应模型分析;对有统计学异质性的研究,用随机效应模型分析。对于不能进行Meta分析则用描述性方法分析结果。结果:Meta分析共纳入13个随机对照试验的2248例患者。结果显示全身系统应用糖皮质激素在一定程度上改善CAP患者的病死率(OR值=0.73,95%CI 0.52~1.05),但两组间的差异并没有统计学意义(P=0.07)。糖皮质激素治疗可以缩短平均住院时间(WMD值为-1.66,95%CI-2.37~-0.94,Z=4.56,P0.00001),降低CAP患者机械通气的发生率(OR值=0.31,95%CI 0.19~0.50,P0.00001),促进患者在胸部影像学上的改善(OR值=10.46,95%CI 1.77~61.83,P=0.01),即可以促使肺部感染病灶的吸收,但却没有缩短那些重症CAP患者的入住ICU的时间(WMD值为-1.74,95%CI-6.59~3.11,Z=0.70,P=0.48)。全身应用糖皮质激素与普通常规治疗相比,总体上安全性尚可,并不会增加上消化道出血(OR值=1.51,95%CI 0.42~5.50,P=0.53)、二重感染(OR值=1.41,95%CI 0.70~2.85,P=0.34)等不良事件的发生率,但可能导致需要胰岛素干预的高血糖症发生率上升(OR值为1.40,95%CI 1.02~1.94,P=0.04)。结论:我们的研究显示糖皮质激素虽然可以缩短CAP患者的平均住院时间,降低患者的机械通气发生率,促进患者胸部影像学改善,且临床应用具有较好的安全性,但不能减少病死率和入住ICU时间。
[Abstract]:Objective: Community-acquired pneumonia (CPAP) is an infection acquired by the community, not pneumonia during hospitalization, which is an important cause of disease and death. The purpose of this systematic evaluation was to determine the efficacy and safety of glucocorticoid in the treatment of adult community-acquired pneumonia. Methods: the published randomized controlled clinical trials of glucocorticoid in the treatment of adult community-acquired pneumonia were systematically evaluated. A computerized search of Pubmedus EMBASEN Cochrane Library (Elisevier), Chinese Biomedical Literature Database, full text Database of Chinese academic Journals, Wanfang Medical Database, and (CNKI), Web-based Chinese Sci-tech Journals Database. The retrieval time is up to December 2015. The key words were community-acquired pneumonia, corticosteroids, glucocorticoids, dexamethasone, hydrocortisone, prednisone and methylprednisolone. Finally, 13 randomized controlled clinical trials were included. Cochrane bias risk assessment tool was used to evaluate the quality of the selected literature, and the Cochrane system evaluation software Rev Man 5.3 was used to analyze the quality of the selected literature. The results of Meta analysis. Meta-analysis showed that the ratio of (OR) and its 95% confidence interval (CI) was used in the two classification variables, and the mean difference (MD) and 95 CIs were used in the continuous variables. For the study of no statistical heterogeneity, the fixed effect model is used to analyze the heterogeneity, and the random effect model is used for the study of statistical heterogeneity. When Meta analysis can not be carried out, descriptive method is used to analyze the results. Results A total of 2248 patients were enrolled in 13 randomized controlled trials. The results showed that systemic use of glucocorticoid improved the mortality of patients with CAP to a certain extent (OR = 0.7395 CI 0.52 卤1.05), but there was no significant difference between the two groups (P0. 07). Glucocorticoid therapy can shorten the average hospitalization time (WMD = -1.6695), reduce the incidence of mechanical ventilation in CAP patients (OR = 0.3195 CI 0.190.50p 0.00001), and promote the improvement of chest imaging (OR = 10.46-9595 CI = 1.7795 CI = 61.83P0.01), that is, it can promote the absorption of pulmonary infection foci. However, the duration of admission to ICU in those patients with severe CAP was not shortened (WMD = -1.74 卤95). Compared with general routine therapy, glucocorticoid was generally safe and did not increase the incidence of adverse events such as upper gastrointestinal bleeding (OR = 1.51 卤95CI 0.42), double infection (OR = 1.41 卤95CI 0.70 ~ 2.85), and double infection (OR = 1.41 ~ 95 CI 0.70 ~ 2.85 / P 0.34). However, the incidence of hyperglycemia requiring insulin intervention may be increased (OR = 1.4095 CI 1.02t 1.94 P0. 04). Conclusion: our study shows that glucocorticoid can shorten the average hospitalization time of CAP patients, reduce the incidence of mechanical ventilation in patients, promote the improvement of chest imaging of patients, and the clinical application of glucocorticoid has better safety. However, the mortality and duration of ICU stay could not be reduced.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R563.1

【相似文献】