苯妥英钠预防颅脑损伤后早期癫痫的Meta分析

目的: 通过系统评价有关苯妥英钠预防颅脑损伤后早期癫痫的文献,评估苯妥英钠预防颅脑损伤后早期癫痫发作的有效性。方法: 在Medline数据库、Pubmed数据库、Embase数据库和Cochrane Library和中国期刊全文数据库(CNKI)、中国生物医学文献数据库(CBM)、万方数据库中输入检索词检索有关苯妥英钠用于颅脑损伤后早期癫痫防治的随机对照试验(randomized controlled trials,RCTs)文献,并且筛选符合纳入标准的文献,提取文献中数据进行Meta分析。采用相对危险度(relative risk,RR)分析早期癫痫的发作率。研究间的异质性采用Q检验法检验,并采用经自由度(文献数)校正后的I²值进行定量。若异质性检验结果为P>0.01,或I²≤50%,用固定效应模型(fixed-effect model)计算合并效应;反之,采用随机效应模型(randomized-effect model)计算合并效应。结果: 共纳入1657位患者在内的8篇文献,861位患者纳入苯妥英钠试验组,796位患者纳入阴性对照组。各文献间异质性不明显(I²=8%,P=0.36),采用固定效应模型对早期癫痫防治作用进行META分析。结果显示,在颅脑损伤中苯妥英钠试验组早期癫痫发作率较对照组低,2组差异有统计学意义(RR=0.38,95%CI:0.26,0.56,P<0.00001);在颅脑创伤中苯妥英钠试验组早期癫痫较对照组低,2组差异有统计学意义(RR=0.33,95%CI:0.19,0.59,P=0.0002);在颅脑外科手术中苯妥英钠试验组早期癫痫发作率较对照组低,2组差异有统计学意义(RR=0.43,95%CI:0.25,0.71,P=0.001)。结论: 苯妥英钠能够有效预防颅脑损伤后早期癫痫发作。

Phenytoin prophylactic therapy against early epilepsy after craniocerebral injury: a meta analysis

OBJECTIVE To evaluate prophylactic efficacy of phenytion against epilepsy after craniocerebral injury by Meta-analysis.METHODS Relevant RCTs were identified by searching electronic databases including Medline, Pubmed, Embase, Cochrane Library, CNKI, CBM and WANFANG.Eligible articles were included to extract data.Relative risk (RR) was used to analyze ratios of early seizures.Inter-study heterogeneity was evaluated by using chi square test-based Q test. I² was a fixed-effect model was employed to calculate pooled effects if P>0.1 or I<50%; otherwise, a randomized-effect model was used.RESULTS A total of 1487 unduplicated papers were identified, and 1378 papers of them were excluded by reading abstracts and titles.Another 101 papers were excluded after reading their complete texts.Eventually 8 papers on random control trials (RCTs) were included.These 8 literatures included 1657 patients, 861 patients in phenytoin group and 796 in placebo or no treatment control group.There was no significant heterogeneity between literatures.Fixed-effect model was used for analysis.Results showed phenytoin group had less early seizures in craniocerebral injury patients (RR=0.38, 95%CI:0.26, 0.56, P<0.00001), craniocerebral trauma patients (RR=0.33, 95%CI:0.19, 0.59, P=0.0002) and craniocerebral surgery patients (RR=0.43, 95%CI:0.25, 0.71, P=0.001) than control group.CONCLUSION Phenytoin can effectively prevent early epilepsy after craniocerebral injury.