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系统性皮质类固醇用于预防支气管肺功能障碍,一个网络元分析
Susanne Hay1, Colleen Ovelman2, John Af Zupancic1
1Department of Neonatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
The Cochrane database of systematic reviews
|August 31, 2023
概括
系统性皮质类固醇如甲和皮质可以帮助预防早产婴儿的支气管肺功能障碍症 (BPD). 中等剂量的德克萨米他早期或高剂量的德克萨米他晚期可能是最有效的,但证据的确定性很低.
科学领域:
- 新生儿医学 新生儿医学
- 儿科肺病学 儿科肺病学
- 药理学 药理学是指药理学的学科.
背景情况:
- 尽管新生儿护理取得了进展,但对出生时体重非常低的婴儿来说,支气管肺功能障碍 (BPD) 仍然是一个重大问题.
- 系统性皮质类固醇用于管理BPD炎症,但平衡有效性和风险的最佳方案尚不清楚.
- 德克萨米他和皮通常被研究,但它们的副作用和最佳使用需要进一步研究.
研究的目的:
- 为了比较各种系统性皮质类固醇治疗方案 (德甲剂量,皮质) 与安慰剂的疗效和安全性,用于预防早产婴儿的BPD.
- 进行网络元分析 (NMA),以生成对对比和治疗排名.
- 评估对BPD,死亡和复合结果的影响,考虑早期和晚期的治疗开始.
主要方法:
- 在2023年1月之前,对数据库 (Cochrane Library,MEDLINE,Embase) 和临床试验注册表进行了系统的搜索.
- 包括随机对照试验 (RCT) 的早产婴儿 (<37周怀孕) 风险 BPD 治疗系统性皮质类固醇.
- 网络元分析 (NMA) 使用频率学随机效应模型,对早期 (<7天) 和晚期 (≥7天) 开始治疗进行单独分析. 格雷德框架评估了证据的确定性.
主要成果:
- 早期治疗:中等剂量的德克萨米他显示,与对照组相比,中等确定性的证据表明,降低了BPD风险. 低剂量德克萨米他增加了脑风险 (中度确定性证据).
- 晚期治疗:高剂量德克萨米他表明,与对照组相比,中度确定性证据表明,减少了BPD和死亡或BPD的复合结果.
- 与低剂量德克萨米他相比,皮显示出低确定性证据,可能减少主要神经感官残疾.
结论:
- 早期开始的中等剂量德克萨米他或晚期开始的高剂量德克萨米他可能为没有BPD的生存提供最佳结果,尽管证据确定性很低.
- 关于这些皮质类固醇治疗方案的长期不良影响的证据不足.
- 需要进行更多具有足够功率的RCT和直接比较,以确定早产婴儿的最佳系统性皮质类固醇策略,重点关注没有重大神经感官残疾的生存.
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