丙戊酸钠联合左乙拉西坦治疗成人癫痫持续状态效果的Meta分析

Sodium valproate and levetiracetam combination treatment for adult status epilepticus: a meta-analysis

目的探讨丙戊酸钠联合左乙拉西坦(LEV)治疗成人癫痫持续状态(SE)的效果。方法通过计算机检索数据库PubMed、Embase、Cochrane Library、Web of Science、知网、维普和万方,收集丙戊酸钠联合LEV治疗成人SE的随机对照试验(RCTs)(检索时间为建库至2018年11月10日),对照组患者接受丙戊酸钠治疗,观察组患者接受丙戊酸钠联合LEV治疗。采用Cochrane风险偏倚评估工具进行文献质量评价,使用Review Manager 5.3软件进行Meta分析。结果纳入10项RCTs,共610例患者。分析后发现丙戊酸钠联合LEV治疗成人SE的效果较好(OR=6.90,95%CI:4.26~11.16,P<0.05),但存在发表偏倚。6项研究描述了药物控制SE所需的时间,逐项移除异质性较大的研究后,发现联合用药与单一使用丙戊酸钠治疗对控制SE所需的时间比较,差异无统计学意义(P=0.05)。结论与单用丙戊酸钠比较,丙戊酸钠联合LEV对成人SE的效果更好,但在控制时间上没有优势。

Objective To investigate the effect of sodium valproate combined with levetiracetam(LEV) in the treatment of adult status epilepticus(SE).Methods The PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Internet, VIP database and Wanfang database were searched by computer to collect randomized controlled trials(RCTs) of sodium valproate combined with LEV for treatment of adult SE from the foundation up to November 10, 2018. Patients in control group were treated with sodium valproate, while patients in observation group were treated with sodium valproate combined with LEV. Cochrane risk bias assessment tool was used to evaluate the quality of literature, and Review Manager 5.3 software was used for meta-analysis.Results A total of 10 RCTs were eligible and included in analysis with 610 patients. After the evaluation, it was found that sodium valproate combined with LEV had a better effect on SE in adults(OR=6.90, 95% CI: 4.26 to 11.16, P<0.05), but there was publication bias. Six studies described the time required to control SE. After removing the studies which had large heterogeneity, it was found that there was no statistical significance in the time required to control SE between the combined use of drugs and the single use of sodium valproate(P=0.05).Conclusion Compared with sodium valproate alone, sodium valproate combined with LEV has better effect for adult SE, but has no advantage in control time.