早产儿生后早期应用糖皮质激素预防支气管肺发育不良的Meta分析

Early postnatal application of glucocorticoids for preventing bronchopulmonary dysplasia in preterm infants: a Meta analysis

目的探讨早期应用糖皮质激素预防早产儿支气管肺发育不良(BPD)的疗效和安全性。方法全面检索Pub Med、Cochrane Library、Embase、中国期刊全文数据库(CNKI)、万方医学网及维普等数据库,收集各数据库从建库至2016年6月有关早产儿早期应用糖皮质激素预防BPD的文献,对符合纳入标准的16项随机对照试验(RCT)应用Review Manager 5.3进行Meta分析。结果 16项RCT共纳入2 962例参与者,其中试验组1 486例,对照组1 476例。Meta分析结果显示,早产儿早期应用糖皮质激素有利于减少纠正胎龄36周时BPD的发生率(OR=0.73,95%CI:0.61~0.87,P=0.0004);但发生高血糖(OR=1.61,95%CI:1.24~2.09,P=0.0003)、高血压(OR=1.63,95%CI:1.11~2.38,P=0.01)、肠穿孔(OR=1.51,95%CI:1.12~2.04,P=0.007)的风险增加。结论目前尚不能推荐早产儿应用糖皮质激素预防BPD,需要进一步研究其优缺点,尤其需注意高血糖、高血压、肠穿孔等不良影响。

Objective To study the clinical effect and safety of early postnatal application of glucocorticoids in the prevention of bronchopulmonary dysplasia （BPD） in preterm infants. Methods The databases including PubMed, Cochrane Library, Embase, CNKI, Wanfang Data, and VIP were comprehensively searched for articles on early postnatal application of glucocorticoids in the prevention of BPD in preterm infants published up to June 2016. Review Manager 5.3 was used for the Meta analysis of 16 randomized controlled trials （RCTs） that met the inclusion criteria. Results A total of 2 962 participants were enrolled in the 16 RCTs, with 1486 patients in the trial group and 1476 in the control group. The Meta analysis showed that early postnatal application of glucocorticoids reduced the incidence rate of BPD at a corrected gestational age of 36 weeks （0R=0.73, 95%CI： 0.61-0.87, P=-0.0004）, but there was an increase in the risk of hyperglycemia （OR=1.61, 95%CI： 1.24-2.09, P=-0.0003）, hypertension （0R=1.63, 95%CI： 1.11-2.38, P=-0.01）, and intestinal perforation （OR=I.51, 95%C1： 1.12-2.04, P=-0.007）. Conclusions At present, it is not recommended to use glucocorticoids to prevent BPD in preterm infants. Its advantages and disadvantages need further studies, with special focuses on the adverse effects of hyperglycemia, hypertension, and intestinal perforation.