CAJ | 학술논문

目的新生儿脓毒症(neonatal sepsis,NS)是新生儿死亡的主要原因之一,免疫治疗是NS综合治疗的重要组成部分.本研究通过检索近年来关于NS免疫治疗的临床证据,探讨其临床应用价值.方法检索MEDLINE、EMBASE数据库和Cochrane图书馆关于NS免疫治疗的系统评价及随机(或半随机)对照试验,并进行分析比较.结果 6个系统评价(共计37个随机对照临床试验)纳入研究,药物包括免疫球蛋白(含高IgM免疫球蛋白)、抗葡萄球菌免疫球蛋白、中性粒细胞、粒细胞集落刺激因子、粒细胞-巨噬细胞集落刺激因子、己酮可可碱、谷氨酸盐.目前研究提示,己酮可可碱的使用能降低NS死亡率(Z =2.71,P=0.006 8)、缩短住院时间(Z=2.01,P=0.044)及减少NS患儿坏死性小肠结肠炎(NEC)的发生率(Z=1.67,P=0.095),其余药物的使用并未见明确疗效.结论关于NS免疫治疗的临床证据表明,到目前为止,仅己酮可可碱能降低NS患儿病死率、减少NS患儿NEC发生率和缩短住院时间,其余药物均表明无明确疗效.现有NS免疫治疗的临床研究存在样本数量小、缺乏多中心研究等问题,需大规模、多中心的临床试验进一步证实免疫治疗的有效性.
목적 신생인농독증(neonatal sepsis,NS)시신생인사망적주요원인지일,면역치료시NS종합치료적중요조성부분.본연구통과검색근년래관우NS면역치료적림상증거,탐토기림상응용개치.방법 검색MEDLINE、EMBASE수거고화Cochrane도서관관우NS면역치료적계통평개급수궤(혹반수궤)대조시험,병진행분석비교.결과 6개계통평개(공계37개수궤대조림상시험)납입연구,약물포괄면역구단백(함고IgM면역구단백)、항포도구균면역구단백、중성립세포、립세포집락자격인자、립세포-거서세포집락자격인자、기동가가감、곡안산염.목전연구제시,기동가가감적사용능강저NS사망솔(Z =2.71,P=0.006 8)、축단주원시간(Z=2.01,P=0.044)급감소NS환인배사성소장결장염(NEC)적발생솔(Z=1.67,P=0.095),기여약물적사용병미견명학료효.결론 관우NS면역치료적림상증거표명,도목전위지,부기동가가감능강저NS환인병사솔、감소NS환인NEC발생솔화축단주원시간,기여약물균표명무명학료효.현유NS면역치료적림상연구존재양본수량소、결핍다중심연구등문제,수대규모、다중심적림상시험진일보증실면역치료적유효성.
Objective Neonatal sepsis (NS) is one of the main causes of neonatal death.Immune therapy is an important way in the comprehensive treatment of NS.This study investigated several databases in order to find the clinical evidence for the immunological treatment of neonatal sepsis (NS),and to explore its clinical application value.Methods Systematic reviews and randomized (or quasi-randomized) controlled trials (RCT) for immunological treatment of NS in newborn infants were searched from the databases of MEDLINE,EMBASE and Cochrane Library.The relevant literatures were statistically analyzed.Results Six systematic reviews (including 37 RCTs) were found to be involved in the therapy,and the drugs included intravenous immunoglobulin (containing high level of IgM),antistaphylococcal immunoglobulins,neutrophile granulocyte,granulocyte colony-stimulating factor,granulocyte-macrophage colony-stimulating factor,pentoxifylline and glutamine.Pentoxifylline could decrease the mortality (Z =2.71,P =0.006 8),shorten the hospitalization (Z =2.01,P =0.044),and reduce the incidence rate of necrotizing enterocolitis (NEC) (Z =1.67,P =0.095) of the NS infants.No therapeutic effect was found for other drugs in the treatment of NS.Conclusions Current clinical evidence for the immunological treatment of NS indicates that only Pentoxifylline could decrease the mortality,reduce the incidence rate of NEC and shorten the hospitalization of infants with NS.However,current evidence is only a small scale sampling and lacks multicenter studies.Researchers are encouraged to undertake large scale and well-designed multicenter trials to confirm the effectiveness of the immunological treatment of NS.