糖皮质激素对肺部感染的住院患者治疗获益的Meta分析

Therapeutic benefit of glucocorticoids in treating pneumonia inpatients: a Meta-analysis

目的肺部感染是临床常见的呼吸系统疾病,指各类病原体(细菌、病毒、真菌等)引起的气管-支气管和肺实质的感染,以感染性肺炎最常见,其中感染性肺炎主要包括社区获得性肺炎和医院获得性肺炎。本文采用Meta分析方法研究糖皮质激素对肺部感染住院患者的治疗获益。方法计算机检索中英文数据库的相关文献,英文数据库包括PubMed、Ovid、EMbase、The Cochrane Library,中文数据库包括万方、知网和CBM。中文检索关键词为"糖皮质激素、类固醇、氢化可的松、甲泼尼龙、泼尼松、地塞米松、布地奈德、社区获得性肺炎(CAP)、医院获得性肺炎(HAP)、肺炎、肺部感染"。英文检索关键词为"steroids,glucocorticoids,hydrocortisone,prednisone,budesonide,cortisol,corticosteroids,methylprednisolone,dexamethasone,community-acquired pneumonia,hospital-acquired pneumonia,pneumonia"。纳入糖皮质激素治疗肺部感染的住院成人患者的随机对照试验,并进行质量评价和数据提取,用Revman5.3软件对所提取数据进行Meta分析。结果共检索972篇文献,最终纳入文献8篇,共纳入1 623例肺部感染患者。Meta分析结果显示,糖皮质激素对所有CAP患者的病死率无明显影响(OR=0.75,95%CI为0.49~1.14,P=0.18),但可降低重症CAP患者的病死率(OR=0.36,95%CI为0.17~0.75,P=0.007),同时可以缩短平均住院日(WMD=-1.92,95%CI为-3.00^-0.84),此外还能明显增加CAP患者需要用胰岛素干预的高血糖的发生率(OR=2.35,95%CI为1.74~3.16,P≤0.00001)。结论糖皮质激素仅应谨慎用于非糖尿病的重症CAP患者。

Objective Pneumonia inpatients,which can be defined as an infection of the trachea,bronchus or pulmonary parenchyma caused by various pathogens（ bacteria,viruses,fungi,etc.）,is one of the most prevalent respiratory diseases. And infectious pneumonia is the most common one,which can be classified to community-acquired pneumonia（ CAP） and hospital-acquired pneumonia（ HAP）. This study aims to evaluate the therapeutic benefit of glucocorticoids in treating pneumonia inpatients by Meta analysis. Methods Randomized trials about glucocorticoids treatment for pneumonia patients were searched in the following databases： PubMed,Ovid,EMbase,the Cochrane Library,Wanfang Data,CNKI and CBM. The keywords included steroids, glucocorticoids, hydrocortisone, prednisone, budesonide, cortisol, corticosteroids,methylprednisolone, dexamethasone, community-acquired pneumonia, hospital-acquired pneumonia, and pneumonia. Only randomized clinical trials（ RCTs） about glucocorticoids treating pneumonia in adult inpatients were included,and Revman5.3 software was used to conduct Meta analysis after methodological evaluation and data extraction. Results A total of 972 articles were reviewed and 8 RCTs involving 1 623 pneumonia patients were included in this Meta analysis. According to the analysis,glucocorticoids could not significantly influence the mortality of all the CAP patients（ OR = 0. 75,95% CI is 0. 49-1. 14,P = 0. 18）,but it could reduce the mortality of severe CAP patients（ OR = 0. 36,95% CI is 0. 17-0. 75,P = 0. 007）. Glucocorticoids can also reduce the hospital stay（ WMD =-1.92,95%CI is 3.00-0.84） and increase the risk of hyperglycemia（ OR =2.35,95%CI is 1.74-3.16,P≤0.00001）. Conclusion Glucocorticoids should only be used with caution in severe CAP patients without diabetes.