产前多疗程与单疗程肾上腺糖皮质激素治疗对早产儿影响的Meta 分析

目的 综合评价产前多疗程与产前单疗程肾上腺糖皮质激素治疗对早产儿的有效性和安全性。方法 对满足条件的7篇有关产前肾上腺糖皮质激素治疗对早产儿影响的队列研究进行Meta分析。结果 产前多疗程肾上腺糖皮质激素治疗可降低早产儿动脉导管未闭(PDA)的发病率(OR=0．51，95％CI0．49～0．54)，有使早产儿呼吸窘迫综合征(RDS)发生率降低的趋势(OR=0．72，95％CI0．49～1．07)。但可增加早产儿败血症的发生率(OR=1．62，95％CI1．07～2．44)，且不能降低早产儿颅内出血(ICH)(OR=0．65，95％CI0．37～1．15)、坏死性小肠结肠炎(NEC)(OR=1．30，95％CI0．79～2．12)和慢性肺疾病(CLD)(OR=0．94，95％CI0.59～1．49)的发生率及病死率(OR=1．07，95％CI0．42～2．75)，也不能使早产儿出生后肺表面活性物质(PS)的应用减少(OR=0．86，95％CI0．48～1．55)。结论 无法根据现有的Meta分析结果证明产前多疗程肾上腺糖皮质激素治疗比产前单疗程肾上腺糖皮质激素治疗更有效和危险性更小。

The Influence of Antepartum Multiple and Single Course Glucocorticoid Treatment on Preterm Birth Infants

Objective To assess the safety and effectiveness of prenatal multiple and single course glucocorticoids treatment on preterm birth infants. Method Seven researches on the treatment of preterm birth infants with glucocorticids were meta analyzed. Results Multiple courses of glucocorticoids treatment before labor may lower the incidence of patent ductus arteriosus (PDA) of preterm babies (OR=0.51,95% CI 0.49~0.54),and so did the respiratory distress syndrome (RDS), (OR=0.72,95% CI 0.49~1.07).But it may increase the septicemia of preterm infants (OR=1.62, 95%CI 1.07~2.44),and could not decrease the morbidity and mortality of intracranial hemorrhage (ICH)(OR=0.65, 95% CI 0.37~1.15)? necrosis enterocolonitis (NEC)(OR=1.30, 95% CI 0.79~2.12)and chronic lung disease (CLD)(OR=0.94,95%IC 0.59~1.49)? It cound not decrease the use of pulmonary surfactant after the birth of preterm infants. (OR=0.86,95% CI 0.48~1.55). Conclusions It suggests that multiple courses treatment with glucocorticoids is not safer and more effective than single course before labor.