甲泼尼龙治疗毛细支气管炎疗效和安全性的Meta分析

目的:探讨甲泼尼龙治疗毛细支气管炎的疗效和安全性.方法:按照系统评价的要求检索中国期刊全文数据库(CNKI)、中国生物医学文献数据库(CBM)、维普中文科技期刊、万方数字化期刊等数据库,全面收集甲泼尼龙治疗毛细支气管炎的随机对照试验( RCT),根据纳入和排除标准筛选文献、资料,进行质量评价并采用Revman4.2软件进行Meta分析.结果:共检索到96篇相关文献,将符合纳入标准的15篇RCT文献进行Meta分析.文献偏倚评价结果显示15篇文献以疗效、喘息消失时间、住院时间做的倒漏斗分析均显示不对称,提示其存在一定的发表偏倚和方法学质量低下.Meta分析结果显示甲泼尼龙治疗毛细支气管炎的总有效率明显高于对照组[ OR=5.54,95％ CI( 3.61,8.50),P＜0.01];能明显缩短住院时间[WMD＝-1.37,95％ CI(-1.74,-1.00),P＜0.01];能明显缩短患儿喘息时间[WMD=-1.23,95％(-1.77,-0.69),P＜0.01].未见甲泼尼龙临床应用相关不良反应的报道.结论:现有证据显示,甲泼尼龙治疗毛细支气管炎有效,未见明显不良反应,安全性较高.鉴于Meta分析的RCT文献数量和质量的限制,影响了结果的准确性,结论还需要更多设计合理、执行严格的多中心大样本RCT进一步证实和支持.

Meta-Analysis of Clinical Efficacy and Safety of Methylprednisolone in Adjuvant Treatment of Bronchiolitis

Objective: To explore the efficacy and safety of methylprednisolone in adjuvant treatment of bronchiolitis.Methods: According to the requirements of the full text retrieval system evaluation from the China Journal Full-text Database(CNKI),Chinese biomedical literature database(CBM),VIP Chinese science and technology periodical,and Wanfang digital periodical database,literatures of methylprednisolone in the treatment of bronchiolitis in randomized controlled trials were collected comprehensively,screened by inclusion and exclusion criteria,evaluated and Meta analyzed by Revman 4.2 software.Results: A total of 96 relevant documents were retrieved,15 RCTs met the inclusion criterion and selected for Meta analysis.Literature bias evaluation results showed funnel plots asymmetry in efficacy,wheezing disappearance time,hospitalization time of 15 articles,suggesting the presence of a publication bias and methodological quality were low,the results of the analysis of Meta display of methylprednisolone in the treatment of bronchiolitis in the total efficiency was significantly higher than that of the control group [OR=5.54,95%CI(3.61,8.50),P<0.01],significantly shorted the time of hospitalization [WMD=-1.37,95%CI(-1.74,-1.00),P<0.01],shorted the time in children with wheezing [WMD=-1.23,95%CI(-1.77,-0.69),P<0.01].No reported clinical application of methylprednisolone related adverse reactions.Conclusions: The existing evidences show methylprednisolone in adjuvant treatment of bronchiolitis seems effective,safe,and no obvious adverse reactions.In view of the restriction of RCT Meta analysis in quantity and quality,the accuracy of the results was affected.A clear conclusion needs more reasonable design,strict implementation of a large multicenter sample of RCT for further confirmed support.