报警器与去氨加压素治疗儿童原发性遗尿症的Meta分析

Meta analysis of the alarm treatment and desmopressin in the treatment of primary nocturnal enuresis in children

目的 通过报警器与去氨加压素治疗原发性遗尿症（PNE）疗效比较的Meta分析,了解报警器治疗及去氨加压素治疗儿童PNE的疗效.方法 检索PubMed、Central、Elesvier、CNKI等数据库,获得报警器治疗与去氨加压素治疗儿童PNE的随机对照研究（RCT）.使用国际Cochrane中心推荐的方法进行数据摘录及质量评价,采用Review Manager 5.0软件对近期及远期疗效、依从性等结果进行合并统计分析.结果 共检索出54篇文献,其中11篇文献纳入研究,纳入的文献中唤醒治疗均采取报警器的方式.分析结果显示以不尿床、遗尿次数≤1次/月、遗尿次数降低≥90％、遗尿次数降低≥50％为结局,报警器治疗及去氨加压素治疗结束时疗效差异无统计学意义.治疗停止后3个月随访,以遗尿次数降低≥50％、遗尿次数≤1次/月为结局,报警器治疗优于去氨加压素治疗.治疗停止6个月后随访,以遗尿次数≤1次/月为结局,二者差异无统计学意义.去氨加压素治疗的复发率高于报警器治疗,差异有统计学意义（P =0.007）,但报警器治疗的退出失访率较高,差异有统计学意义（P ＜0.000 01）.报警器治疗及去氨加压素治疗均无严重不良反应发生.结论 报警器与去氨加压素的近期疗效无差别,远期疗效报警器优于去氨加压素;报警器疗效肯定,但退出失访率较高.去氨加压素依从性优于报警器,但复发率较高.

Objective To explore the therapy efficacy for children with primary nocturnal enuresis by meta-analysis on the efficiency of alarm treatment versus desmopressin.Methods PubMed, Central, Elesvier, CNKI and some other databases were browsed to obtain all randomized controlled trails（RCT） and to compare the therapy between alarm treatment and desmopressin.Data extraction and quality evaluation were done by methods recommended by Cochrane center.The results of short-term and long-term efficacy and compliance were analyzed by Review Manager 5.0.Results Fifty-four RCT were retrieved and 11 RCT were included in the study.There was no statistical difference between alarm treatment and desmopressin when analyzing by no wetting episode,wetting no more than 1 night per month,wetting nights＆#39; decrease over 90% or wetting nights decrease over 50%.By 3-month follow-up after treatment stopped,alarm treatment significantly reduced the wetting nights to over 50% or less than 1 night per month than desmopressin.By 6-month follow-ups after treatment stopped, there was no difference between alarm treatment and desmopressin when analyzed by wetting no more than 1 night.The relapse rate of desmopressin was higher than that of alarm treatment （P =0.007）.However, the withdrawal and abandonment rate of alarm treatment was higher than that of desmopressin（P 〈0.000 01）.Severe adverse effects were not found in both of the treatment groups.Conclusions There is no statistical difference between alarm and desmopressin therapy in short-term treatment.The efficiency of alarm device is better than that of desmopressin in long-term treatment.The follow-up of alarm treatment lost more than that of desmopressin.Desmopressin is better than the alarm treatment in compliance but has higher recurrence rate.