糖皮质激素治疗社区获得性肺炎疗效及安全性Meta分析

摘要

Objective To evaluate efficacy and safety of glucocorticoids for community-acquired pneumonia (CAP).Methods We searched relevant randomized controlled trials (RCT) from Pubmed,EMBASE,Cochrane Library,Chinese Journal Full-text Database,Chinese Biomedical Literature Database and traced the related reference to obtain the information that had not been found by using key words of steroids,glucocorticoids,cortisol,corticosteroids,community acquired pneumonia and CAP.The quality of RCT included was evaluated.Meta-analysis was performed with RevMan 5.0 provided by the Cochrance Collaboration.Results Seven RCTs involving 944 patients were included in the meta-analysis.Mean length of hospital stay in glucocorticoids treatment group was significant shorter than that in conventional treatment group (WMD =-1.70,95％ CI:-2.01-1.39,Z =10.81,P ＜0.01).No significant differences were found regarding mortality (RR =0.77,95％ CI 0.46-1.27,Z =1.03,P =0.30),mean length of ICU stay (WMD =1.17,95％ CI:-1.68-4.02,Z =0.81,P =0.42),the risk of double infection (RR =1.32,95％ CI 0.66-2.63,Z=0.79,P=0.43),the incidence of hyperglycemia (RR=1.84,95％ CI0.76-4.41,,Z=1.36,P=0.17),the incidence of upper gastrointestinal bleeding (RR =1.98,95％ CI O.37-10.59,Z =0.80,P =0.42) between conventional treatment group and glucocorticoids treatment group.Conclusions Glucocorticoids treatment used in patients with community-acquired pneumonia may shorten the course of illness and possess better safety,but could not reduce the mortality.%目的 系统评价糖皮质激素治疗社区获得性肺炎(community-acquired pneumonia,CAP)的疗效及安全性.方法 以steroids、glucocorticoids、cortisol、corticosteroids、community-acquired pneumonia、CAP为检索词检索Pubmed、Embase数据库及Cochrane图书馆临床对照试验数据库.中文检索词为糖皮质激素、氢化可的松、地塞米松、社区获得性肺炎.同时检索纳入文献的参考文献,对纳入文献逐个进行质量评价和资料提取.进行统计学分析,计数资料采用相对危险度;计量资料计算加权均数差.采用RevMan 5.0软件对数据合并进行统计分析.结果 纳入7篇英文文献,共944例患者.糖皮质激素治疗组较常规治疗组平均住院日缩短(WMD=-1.70,95％CI为-2.0t～-1.39,Z=10.81,P＜0.01),差异具有统计学意义;病死率下降(RR =0.77,95％ CI为0.46 ～1.27,Z=1.03,P=0.30),ICU平均住院日延长(WMD=1.17,95％CI为-1.68～4.02,Z=0.81,P=0.42),二重感染危险性增加(RR=1.32,95％C7为0.66～2.63,Z=0.79,P=0.43),高血糖发生率增加(RR=1.84,95％CI为0.76 ～4.41,Z=1.36,P=0.17),上消化道出血危险性增加(RR=1.98,95％CI为0.37～ 10.59,Z=0.80,P=0.42),但差异无统计学意义.结论 研究提示糖皮质激素治疗社区获得性肺炎可以缩短病程,安全性较好,但不能降低病死率.