在早产新生儿中预防支气管肺功能障碍的宏类药物
Kristin L O'Connor1, Jane Cracknell2, Chris Cooper3
1Newborn Intensive Care Unit, The Royal Children's Hospital, Melbourne, Australia.
The Cochrane database of systematic reviews
|February 9, 2026
概括
像阿齐思罗米这样的宏类抗生素在预防早产婴儿的支气管肺功能障碍症 (BPD) 中几乎没有益处. 虽然它们可能会略微减少婴儿死亡率和胃肠道疾病,但其他结果的证据仍然不确定.
科学领域:
- 新生儿医学 新生儿医学
- 药理学 药理学是指药理学的学科.
- 呼吸系统医学 呼吸系统医学
背景情况:
- 支气管肺功能障碍症 (BPD) 是早产的一个常见并发症,是影响不成熟肺部的复杂相互作用造成的.
- 麦克罗利德,如阿齐思罗米,具有抗炎性质,这表明在预防BPD方面有潜力.
- 本综述重点关注高风险婴儿:输管和通风的非常早产和出生时体重非常低的新生儿.
研究的目的:
- 评估类抗生素在预防早产新生儿BPD中的疗效和安全性,与安慰剂或没有干预相比.
- 为了在早产新生儿中预防BPD,比较不同的类亚型.
主要方法:
- 随机和准随机对照试验的系统审查和元分析.
- 搜索了至2025年6月的CENTRAL,MEDLINE,Embase和试验注册表.
- 包括需要机械通风的非常早产 (<32周GA) 或出生体重非常低 (<1500g) 的婴儿.
主要成果:
- 在36周的月经后年龄 (PMA) 中,使用麦克罗利德在BPD率上几乎没有差异 (RR 0.95,低确定性证据).
- 观察到出院前死亡率略有减少 (RR 0.89,低确定性证据).
- 麦克罗利德可以减少胃肠道不适 (RR 0.47) 和产后类固醇使用 (RR 0.74),但其他危害 (肝功能障碍,QTc延长,甲状腺狭窄) 的证据有限或不确定.
结论:
- 麦克罗利德的使用,特别是阿齐思罗米,在高风险的早产婴儿中预防BPD的益处很小,甚至没有任何益处.
- 潜在的好处包括轻微减少死亡率和胃肠道不适.
- 由于证据不确定性低,结果测量不准确,需要进一步研究.
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