泼尼松龙与促肾上腺糖皮质激素治疗婴儿痉挛症的Meta分析

Effect of prednisolone and adrenocorticotropic hormone in the treatment of infantile spasms: a Meta analysis

目的比较泼尼松龙与促肾上腺糖皮质激素(ACTH)治疗婴儿痉挛症(IS)的疗效和安全性.方法通过检索Cochrane Library、Embase、PubMed、中国生物医学文献数据库、中国知网和万方数据库等中英文数据库,收集比较泼尼松龙与ACTH治疗IS的临床研究,进行文献筛选、资料提取和质量评价,采用Review Manager 5.3软件进行Meta分析.结果根据文献纳入、排除标准,最终纳入5项研究.Meta分析结果显示,泼尼松龙治疗组和ACTH治疗组痉挛缓解率、痉挛缓解时间、并发感染率和易激惹率的比较差异均无统计学意义(P>0.05),而ACTH治疗组的EEG高峰节律紊乱消失率高于泼尼松龙组(P<0.05).结论现有证据未显示采用泼尼松龙和ACTH治疗IS的临床疗效有差异,但ACTH在稳定EEG上更具优势;感染、易激惹等不良反应的发生在两种疗法中也未见差异.

Objective To compare the effect and safety of prednisolone and adrenocorticotropic hormone (ACTH) in the treatment of infantile spasms (IS). Methods Cochrane Library, Embase, PubMed, China Biology Medicine Disc, CNKI, and Wanfang Data were searched for clinical studies on the comparison between prednisolone and ACTH in the treatment of IS. Literature screening, data extraction, and quality assessment were performed. Review Manager 5.3 was used for Meta analysis. Results Five clinical studies were included according to the inclusion criteria and exclusion criteria. Meta analysis showed that there was no significant difference in the spasm remission rate, spasm remission time, complicating infection rate, and irritability rate between the prednisolone and ACTH treatment groups (P>0.05), but the disappearance rate of hypsarrhythmia in the electroencephalogram was higher in the ACTH treatment group than in the prednisolone treatment group (P<0.05). Conclusions The available evidence shows no difference in the clinical efficacy of prednisolone versus ACTH in the treatment of IS. However, ACTH is superior to prednisolone in stabilizing EEG. The two therapies have no difference in the incidence of adverse reactions such as infection and irritability.