糖皮质激素联合环磷酰胺治疗百草枯中毒疗效的Meta分析

Glucocorticoid combined with cyclophosphamide treating paraquat poisoning

目的通过Meta分析探讨糖皮质激素联合环磷酰胺对患者病死率的影响。方法检索MEDLINE（1966年1月至2012年3月）、OVID（1980年1月至2012年3月）、EMBASE（1980年1月至2012年3月）、中国生物医学文献数据库（CBM）（1978年1月至2012年3月）、中文生物医学期刊文献数据库（CMCC）（1995年1月至2012年3月）和中国医学学术会议论文数据库（CMAC）（1994年1月至2012年3月），筛选m比较基础治疗与糖皮质激素联合环磷酰胺治疗百草枯中毒、终点观察指标为病死率的随机对照试验（RCT）。合并效应量，计算相对危险度（RR）和95％置信区间（95％CI）。结果收集到3个RCT，共有164例中重度百草枯中毒患者。与基础治疗（病死率为81．9％）比较，糖皮质激素联合环磷酰胺治疗（病死率为56．8％）降低百草枯中毒病死率的相对危险是0．56（95％C10．29—1．05，P=0．07）。各研究存在明显异质性和发表偏倚。结论糖皮质激素联合环磷酰胺治疗或许可降低中重度百草枯中毒的病死率。南于RCT数量少，并且存在明显异质性和发表偏倚，需要设计良好的RCT以证实其确切的疗效。

Objective To assess the effect of glucocorticoid combined with cyclophosphamide on mortality in patients with paraquat poisoning using meta-analysis. Methods The MEDLINE （from January 1966 to March 2012） , OVID （from January 1980 to March 2012） , EMBASE （from January 1980 to March 2012） , Chinese biomedical literature ＆ retrieval system （CBM） （from January 1978 to March 2012）, Chinese medical current contents （CMCC） （ from January 1995 to March 2012） and Chinese medical academic conference （ CMAC ） （ from January 1994 to March 2012 ） were searched. Studies were included if the study design was a randomized controlled trial （RCT）. Relative risk （RR） and 95% confidence interval （CI） were used to analyze the effect. Results The study included three RCTs with a total of 164 participants with moderate to severe paraquat poisoning. The RR of glucocorticoid combined with cyclophosphamide （mortality rate： 56. 8% ） in decreasing mortality of paraquat poisoning was 0.56 （95% CI 0. 29-1.05, P = 0.07） , compared with basic therapy （mortality rate： 81.9% ）. There were significant heterogeneity and publication bias. Conclusions Combined treatment with glucocorticoid and cyclophosphamide may decrease mortality of patients with moderate to severe paraquat poisoning. Due to the small number of RCTs, significant heterogeneity and publication bias, a large RCT which is well designed is required to validate the efficacy of combined treatment with glucocorticoid and cyclophosphamide in patients with moderate to severe paraquat poisoning.