纤维性肺病中的系统性皮质类固醇:系统性审查和元分析
Tyler Pitre1, Leticia Kawano-Dourado2, George V Kachkovski3
1Division of Respirology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada tyler.pitre@medportal.ca.
BMJ open respiratory research
|December 30, 2023
概括
在纤维化间歇性肺病 (fILD) 中对皮质类固醇的证据有限. 虽然对非异形性肺纤维化 (IPF) 有潜在的益处,但它们对IPF死亡率和FVC下降的影响仍然不确定,需要进一步研究.
科学领域:
- 肺部病理学 肺部病理学
- 类风湿病学 类风湿病学
- 临床药理学 临床药理学
背景情况:
- 纤维化间歇性肺部疾病 (fILD) 包含一组由肺部痕特征的渐进性肺部疾病.
- 皮质类固醇通常用于炎症性肺部疾病,但它们在fILD中的有效性尚未得到充分证实.
- 需要综合现有证据,以指导临床实践和未来的FIELD管理研究.
研究的目的:
- 系统地审查和分析关于在患有纤维性间歇性肺病 (fILD) 的患者中使用皮质类固醇的现有证据.
- 评估皮质类固醇对儿童死亡率和强迫生命能力 (FVC) 降低的影响.
- 为 fILD. 提供随机嵌入式多因素适应性平台试验的设计信息.
主要方法:
- 在主要数据库 (Embase,Medline,Cochrane CENTRAL,Web of Science) 进行了系统的文献搜索,截至2023年4月.
- 包括的研究将皮质类固醇与标准护理,安慰剂或成人fILD患者没有治疗进行比较.
- 随机效应元分析被用来估计对死亡率 (相对风险) 和FVC下降 (平均差异) 的影响.
主要成果:
- 纳入了10项观察性研究,涉及1639名患者.
- 与没有治疗相比,皮质类固醇对死亡率 (RR 1.03) 和FVC下降 (MD 4.29%) 有不确定的影响,证据确定性非常低.
- 观察到一个潜在的好处是减少非异形性肺纤维化 (IPF) 的FVC下降 (MD 10.89%,低确定性证据),但IPF的影响是不确定的 (MD -3.80%,非常低确定性证据).
结论:
- 目前关于皮质类固醇在儿童治疗中的有效性和安全性的证据有限,确定性低.
- 对死亡率和FVC下降的不确定的影响凸显出一个重要的研究缺口.
- 随机对照试验对于确定皮质类固醇在治疗纤维化间歇性肺病中的作用至关重要.
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