重组人类促红细胞生成素治疗新生儿缺血缺氧性脑病疗效及安全性Meta分析

Effect and safety of rhEPO in the treatment of neonatal hypoxia ischemic encephalopathy:a systematic review and Meta-analysis

目的系统评价重组人类促红细胞生成素(rhEPO)治疗新生儿缺血缺氧性脑病(HIE)的疗效及安全性。方法检索CNKI、PubMed、Cochrane等数据库,收集并评价文献,提取数据进行Meta分析。结果共纳入14个研究。rhEPO治疗组与对照组HIE患儿的病死率无明显差异(OR=0.60,95%CI:0.18-1.98),但rhEPO治疗组脑瘫(OR=0.41,95%CI:0.17-0.99)、智力低下发生率(OR=0.37,95%CI:0.18-0.75)下降,新生儿行为神经评估(NBNA)评分(WMD=2.80,95%CI:1.72-3.88)、发育商(DQ)评分(WMD=11.65,95%CI:6.97-16.34)明显提高,且在亚组分析中重度患儿改善尤甚。在安全性方面,两组不良反应无明显差异(P>0.05)。结论 rhEPO可改善HIE患儿神经系统预后,但不能降低其病死率,具有较好的安全性。由于纳入文献数量有限,对此结论的推广仍应谨慎。

Objective To assess the effectiveness and safety of recombinant human erythropoietin （rhEPO） in Ihe treatment of hypoxic ischemic encephalopathy （HIE） neonates. Methods CNKI,PubMed and Cochrane Library were searched. The relevant meeting records were manually searched. Quality assessments of RCTs were carried out. Results Fourteen studies were included. The difference of mortality between two groups had no significance（OR = 0.60, 95%CI： 0.18-1.98 ）. But in rhEPO group, the incidence of cerebral palsy and mental retardation was lower and the pooled ORs for them were （OR = 0.41,95%CI ： 0. 17-0.99） and （OR = 0.37,95%CI ： 0.18-0.75）, respectively. Scores of NBNA （WMD = 2.80, 95%CI： 1.72-3.88） and DQ （WMD = 11.65,95%CI： 6.97-16.34） were better in rhEPO group. In the aspect of safety, the incidence of side reaction was not significantly different, P 〉 0.05. Conclusion Though rhEPO can＇t decrease the mortality of HIE neonates, it can improve neonatal mental prognosis and the therapy is safe by now. However, this conclusion should be extended cautiously because of the limited number of studies.