摘要
目的系统评价全身应用糖皮质激素对慢性阻塞性肺疾病(简称慢阻肺)急性加重患者治疗的有效性及安全性,以期为临床慢阻肺急性加重患者糖皮质激素给药方式的选择提供证据。方法计算机检索Pub Med、EMbase、The Cochrane Library(2015年第6期)、Wanfang Data、CBM、CNKI,查找有关全身应用糖皮质激素对慢阻肺急性加重患者治疗效果的随机对照临床试验(RCT)。检索时限均为建库至2015年7月。由两位研究者严格按照纳入与排除标准独立筛选文献、提取资料和评价质量,并相互交叉核对结果,如遇分歧则讨论解决,若无法达成一致,则交由第三位研究者协助裁定。数据提取完毕后采用Rev Man 5.3软件进行Meta分析。结果最终纳入11个RCT,共计1 298例患者。Meta分析结果显示:糖皮质激素组治疗成功率显著高于对照组(RR=1.11,95%CI 1.01~1.21,P=0.02);ICU及急诊室糖皮质激素组治疗成功率与对照组相比差异无统计学意义(RR=0.98,95%CI 0.90~1.08,P=0.74;RR=1.19,95%CI 0.84~1.69,P=0.34)。结论全身应用糖皮质激素可显著提高治疗成功率,但对急诊室、ICU患者治疗成功率的影响尚待评估。受样本量及原始资料的限制,本研究尚需更多高质量研究加以验证。
Objective To systematically evaluate the effect and safety of systemic corticosteroids for acute exacerbation of chronic obstructive pulmonary disease （COPD）. Methods Databases including PubMed, EMbase, The Cochrane Library （Issue 6, 2015）, Wanfang Data, CBM, CNKI were searched to collect randomized controlled trails （RCTs） about systemic corticosteroids for acute exacerbation of COPD from inception to July 2015. The meta-analysis was conducted using RevMan 5.3 software. Results A total of 11 RCTs involving 1298 patients were included. The results of meta-analysis showed that a statistically significant increase in the treatment success rate when using systemic corticosteroids （RR=I.ll, 95%CI 1.01-1.21, P=0.02）, and a non-significant difference of effect in the subgroup of emergency department and ICU patients （RR=0.98, 95%CI 0.90-1.08, P=0.74; RR=I.19, 95%CI 0.84-1.69, P=0.34）. Conclusions Current studies suggest that systemic corticosteroids is beneficial in terms of treatment success rate, but subgroup analysis shows that this benefit is controversial in emergency department and ICU. however, due to the limited quantity of the included studies, the above conclusions still need more high quality research to be verified.
出处
《中国呼吸与危重监护杂志》
CAS
CSCD
北大核心
2017年第1期1-8,共8页
Chinese Journal of Respiratory and Critical Care Medicine
基金
新疆维吾尔自治区自然科学基金(2014211C025)
关键词
慢性阻塞性肺疾病
糖皮质激素
系统评价
META分析
Chronic obstructive pulmonary disease
Corticosteroids
Systematic review
Meta-analysis
