地塞米松治疗重度哮喘和脓毒血症的系统评价

System Review on Curative Effect and Safety of Dexamethasone for Severe Asthma and Severe Sepsis

目的:系统评价地塞米松对重度哮喘和脓毒血症等临床急症的疗效和安全性。方法:检索Cochrane图书馆(1996～2007年)、PubMed(1966～2007年)、EMCC(1995～2007年)、CHKD(1994～2007年)等数据库以及查阅相关文献的参考文献,纳入地塞米松治疗重度哮喘和脓毒血症的所有随机对照试验,逐个进行质量评价和资料提取,并进行Meta分析。结果:符合纳入标准的研究11个,共1435例。治疗重度哮喘:(1)总体症状缓解率:地塞米松与泼尼松比较,差异无统计学意义[OR1.44,95%CI(0.75,2.75);P=0.27];(2)药品不良反应发生率:地塞米松低于泼尼松[OR0.13,95%CI(0.04,0.44);P=0.001];(3)复发率:地塞米松与泼尼松比较,差异无统计学意义[OR0.58,95%C(I0.25,1.31);P=0.19]。治疗脓毒血症:(1)死亡率:地塞米松与安慰剂比较,差异无统计学意义[OR0.85,95%CI(0.41,1.78);P=0.67];(2)药品不良反应发生率:地塞米松与安慰剂比较,差异无统计学意义[OR1.05,95%C(I0.51,2.19);P=0.89]。结论:对于重度哮喘,地塞米松的疗效与泼尼松相似,但其安全性强于泼尼松;对于脓毒血症,地塞米松的安全性与安慰剂相似。

OBJECTIVE：To evaluate the curative effect and safety of dexamethasone for severe asthma and severe sepsis systematically. METHODS：Randomized controlled trials about dexamethasone for severe asthma and severe sepsis were retrieved from database,such as Cochrane library（1996～2007）,PubMed（1966～2007）,EMCC（1995～2007）,CHKD（1994～2007）and pertinent literatures. The qualities of included studies were evaluated and extracted data were analyzed by Meta-analysis respectively. RESULTS：11 trials containing 1 435 cases were up to included standard. Therapy results of severe asthma：（1）in remission rate of the total symptom,difference between dexamethasone and prednisone was not statistically significant [OR 1.44,95%CI（0.75, 2.75）;P=0.27];（2）In the incidence rate of ADR,dexamethasone was lower than prednisone [OR 0.13,95%CI（0.04,0.44）;P= 0.001];（3）In the recurrence rate,no statistical significance was noted in difference between dexamethasone and prednisone [OR 0.58,95%CI（0.25,1.31）;P=0.19]. Therapy results of severe sepsis：（1）In the mortality,difference between dexamethasone and placebo was not statistically significant [OR 0.85,95%CI（0.41,1.78）;P=0.67];（2）In the incidence rate of ADR,no statistical significance was noted in difference between hydrocortisone and placebo [OR 1.05,95%CI（0.51,2.19）;P=0.89]. CONCLUSION： Dexamethasone is similar to prednisone in the treatment of severe asthma but better than prednisone in drug safety. The safety of dexamethasone is similar to placebo in the treatment of severe sepsis.