皮质类固醇用于改善HELLP综合征患者相关结果:系统性审查和元分析
Asmaa F Kasem1, Hamdy B Alqenawy2, Marwa A Elgendi1
1Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Ramses Street, Cairo, 11591, Egypt.
BMC pregnancy and childbirth
|July 18, 2024
概括
皮质类固醇对HELLP综合征的影响对于孕产妇死亡和其他关键结果仍然不确定. 需要更严格的试验来澄清皮质类固醇治疗在血液溶解,肝酶升高和低血小板 (HELLP) 综合征中的益处和风险.
科学领域:
- 产科和妇科 产科和妇科
- 孕产妇和胎儿医学 孕产妇和胎儿医学
- 关键护理医学 关键护理医学
背景情况:
- 血液溶解,肝酶升高和低血小板 (HELLP) 综合征是一种严重的产科并发症.
- 皮质类固醇治疗有时使用,但其有效性仍有争议.
- 这一系统性审查评估了皮质类固醇与安慰剂或没有治疗HELLP综合征的患者相关结果.
研究的目的:
- 系统地审查关于皮质类固醇在治疗HELLP综合征中的有效性的证据.
- 评估皮质类固醇对孕产妇死亡率,发病率和围产期结局的影响.
- 为了确定这些影响的证据的确定性.
主要方法:
- 随机对照试验 (RCT) 的最新系统综述和元分析.
- 搜索了多个数据库 (CENTRAL,MEDLINE/PubMed,科学网,Scopus) 截至2024年2月.
- 使用Cochrane的RoB 2工具评估偏差风险和使用GRADE的证据确定性.
主要成果:
- 包括15项涉及821名女性的试验.
- 对皮质类固醇对孕产妇死亡的影响的证据确定性非常低 (RR 0.77,95% CI 0.25-2.38).
- 对肺,透析,肝病和围产期死亡的影响也是不确定的,因为证据的确定性非常低;一些证据表明对血小板输血的影响很小,可能会轻微减少急性功能衰竭.
结论:
- 对HELLP综合征的皮质类固醇的有效性对于母亲死亡和发病率等关键结果是不确定的.
- 非常低的确定性证据需要在解释当前发现时谨慎.
- 有足够的动力,严格的试验对于解决这些不确定性至关重要.
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