不同疗程全身糖皮质激素对AECOPD患者的疗效与安全性Meta分析

Efficacy and Safety of different durations of Systemic corticosteroid therapy for COPD exacerbations:A meta-analysis of randomized controlled trials

目的通过系统评价比较不同疗程全身糖皮质激素治疗对AECOPD患者的有效性与安全性。方法计算机检索PubMed,EMBASE数据库,Cochrane图书馆中关于对AECOPD患者全身使用糖皮质激素的所有文献(使用随机对照实验)。检索时间从建库至2016年1月,并由2名评价者独立筛选文献、提取资料并评估纳入研究偏倚风险后,采用RevMan 5.0软件进行Meta分析。激素组按照疗程分为短期组(≤3天)和长期组(>3天),分别在两组中按照起始剂量80mg泼尼松为界限分为高剂量组(≥80mg/d)和低剂量组(<80mg/d)两个亚组,并进行分析。结果纳入文献11篇,涉及1142例患者。其中10篇文献涉及肺功能FEV1,在短期组中使用SCS后病人FEV1明显提高,Meta分析结果显示[MD=0.13,95%CI(0.08,019)],在短期组的中高剂量组为[MD=0.09,95%CI(0.03,0.16)],低剂量组为[MD=0.23,95%CI(0.12,0.33)],差异均有统计学意义。长期组与对照组比较,FEV1差异无统计学意义[MD=0.06,95%CI(-0.01,012)];在长期组的中低剂量组与对照组比较,差异有统计学意义[MD=0.14,95%CI(0.05,0.22)],高剂量组无统计学意义[MD=-0.06,95%CI(-0.16,0.04)]。激素组与对照组不良反应患者中,发生高血糖的Meta分析结果显示[OR=3.94,95%CI(2.15,7.24)],高剂量组[OR=3.50,95%CI(1.73,7.05)],低剂量组[OR=5.48,95%CI(1.58,18.96)],高低剂量激素组发生糖尿病的风险均较对照组增加,差异均有统计学意义。激素组与对照组及不同剂量亚组中二重感染、高血压、胃肠道出血等不良反应比较,差异无统计学意义。结论AECOPD患者行全身糖皮质激素治疗以低剂量短期疗法的效果较好,安全性更高。

Objective To compare the efficacy and safety of short-duration （three days or fewer） and longer-duration （more than three days） SC treatment of acute COPD exacerbations. Methods We electronically searched PubMed, EMBASE, the Cochrane Library databases, and references of reviews or meta-analyses to identify randomized controlled trials using SCS in AECOPD. We conducted the last search in January 2016. Two reviewers independently screened literature,extracted data and assessed the risk of bias of included studies. Then meta analysis was conducted by RevMan 5.0 software. Short-duration （three days or fewer）and longer-duration （more than three days）. In the short-duration and long-duration group respectively according to the initial dose of 80 mg prednisone as boundaries are divided into high dose （80 mg/d or more than） and low dose group （fewer than 80 rag/d） two subgroups are analyzed. Results We identified eleven studies including 1142 participants; ten studies involves lung function FEV1, SCS use was associated with a significant improvement in FEV1 of patients, （ MD= 0.13,95 CI 0.08 to 0.19,P〈0. 001）. In the short-duration group,high dose SCS （MD=0.09,95%CI 0.03 to 0.16,P〈0. 05）,low dose SCS （MD=0. 23,95%CI 0. 12 to 0.33,P〈0. 0001）,FEVI（MD=0. 06,95%CI 0. 01 to 0.2,P〉0. 05）. In the long-duration group low dose group （MD= 0. 14,95 G CI 0.05 to 0.22, P〈0.05 ）, High dose group （MD=0.06,95%CI（-0. 16 to 0. 04,P〉0. 05）. hyperglycemia[OR= 3.94,95%CI （2. 15 toT. 24）],High dose group[OR=3.50,95GCI （1.73,7.05）] ,low dose groud[OR= 5.48,95%CI （1.58,18.96）]. corticosteroid group than the control group were increased the risk of developing diabetes, Double infection,high blood pressure, gastrointestinal bleeding there was no statistically significant difference between groups. Conclusion Systemic corticosteroids in the treatment of AECOPD patients,low doses of short-term therapy better security is higher.