国际流行病学传染病学杂志
國際流行病學傳染病學雜誌
국제류행병학전염병학잡지
INTERNATIONAL JOURNAL OF EPIDEMIOLOGY AND INFECTIOUS DISEASE
2015年
2期
110-114
,共5页
王雯%王东%方明明%张波
王雯%王東%方明明%張波
왕문%왕동%방명명%장파
脓毒症%糖皮质激素%Meta分析
膿毒癥%糖皮質激素%Meta分析
농독증%당피질격소%Meta분석
Sepsis%Steroids%Meta-analysis
目的 系统评价小剂量糖皮质激素治疗脓毒血症的疗效.方法 检索Medline、Embase、TheCochrane Library和中国期刊全文专题数据库、中国生物医学文献数据库、中国科技期刊数据库、万方数据库,用RevMan5.3进行Meta分析,并根据促肾上腺皮质激素(ACTH)兴奋试验结果进行亚组分析.结果 共纳入11篇文献,总患者1 187例.Meta分析结果显示:小剂量糖皮质激素不能降低脓毒血症患者28 d病死率(n=11,I2=27％,OR=0.86,95％CI:0.68～1.09,P＞0.05),可改善7d休克逆转(n=6,I2=0％,OR=2.13,95％CI:1.62～2.80,P＜0.01)及28 d休克逆转情况(n=6,I2=0％,OR=1.52,95％CI:1.14～2.02,P＜0.01).ACTH兴奋试验对判断糖皮质激素治疗脓毒血症疗效无影响(合并I2=0％,OR=0.86,95％ CI:0.66～1.12,P＞0.05).结论 小剂量糖皮质激素对脓毒血症患者短期病死率无效,但能够改善危重脓毒症患者的血流动力学状况和预后.ACTH兴奋试验无法判断糖皮质激素治疗脓毒症的疗效.
目的 繫統評價小劑量糖皮質激素治療膿毒血癥的療效.方法 檢索Medline、Embase、TheCochrane Library和中國期刊全文專題數據庫、中國生物醫學文獻數據庫、中國科技期刊數據庫、萬方數據庫,用RevMan5.3進行Meta分析,併根據促腎上腺皮質激素(ACTH)興奮試驗結果進行亞組分析.結果 共納入11篇文獻,總患者1 187例.Meta分析結果顯示:小劑量糖皮質激素不能降低膿毒血癥患者28 d病死率(n=11,I2=27％,OR=0.86,95％CI:0.68～1.09,P＞0.05),可改善7d休剋逆轉(n=6,I2=0％,OR=2.13,95％CI:1.62～2.80,P＜0.01)及28 d休剋逆轉情況(n=6,I2=0％,OR=1.52,95％CI:1.14～2.02,P＜0.01).ACTH興奮試驗對判斷糖皮質激素治療膿毒血癥療效無影響(閤併I2=0％,OR=0.86,95％ CI:0.66～1.12,P＞0.05).結論 小劑量糖皮質激素對膿毒血癥患者短期病死率無效,但能夠改善危重膿毒癥患者的血流動力學狀況和預後.ACTH興奮試驗無法判斷糖皮質激素治療膿毒癥的療效.
목적 계통평개소제량당피질격소치료농독혈증적료효.방법 검색Medline、Embase、TheCochrane Library화중국기간전문전제수거고、중국생물의학문헌수거고、중국과기기간수거고、만방수거고,용RevMan5.3진행Meta분석,병근거촉신상선피질격소(ACTH)흥강시험결과진행아조분석.결과 공납입11편문헌,총환자1 187례.Meta분석결과현시:소제량당피질격소불능강저농독혈증환자28 d병사솔(n=11,I2=27％,OR=0.86,95％CI:0.68～1.09,P＞0.05),가개선7d휴극역전(n=6,I2=0％,OR=2.13,95％CI:1.62～2.80,P＜0.01)급28 d휴극역전정황(n=6,I2=0％,OR=1.52,95％CI:1.14～2.02,P＜0.01).ACTH흥강시험대판단당피질격소치료농독혈증료효무영향(합병I2=0％,OR=0.86,95％ CI:0.66～1.12,P＞0.05).결론 소제량당피질격소대농독혈증환자단기병사솔무효,단능구개선위중농독증환자적혈류동역학상황화예후.ACTH흥강시험무법판단당피질격소치료농독증적료효.
Objective To systematically assess the benefits and risks of low-dose steroids during the treatment of sepsis.Methods The articles of randomized controlled trials of low-dose steroids versus placebo (or supportive treatment alone)were searched in the Medline,Embase,The Cochrane Library,CNKI,CBMDisc,and Wanfang.The relevant information was meta-analyzed by RevMan 5.3,and the subgroup analysis was done by using the result of adrenocorticotrophic hormone (ACTH) stimulation test.Results Totally eleven publications containing 1 187 cases were included.The meta analysis showed that low-dose steroids did not reduce 28 d mortality (n=1 1,I2=27％,OR=0.86,95％CI:0.68-1.09,P＞0.05).Low-dose steroids therapy ameliorated shock at 7 d (n=6,I2=0％,OR=2.13,95％CI:1.62-2.80,P＜0.01)and 28 d (n=6,I2=0％,OR=1.52,95％CI:1.14-2.02,P＜ 0.01).There was no effect of response to ACTH stimulation testing concerning the effects of steroids (I2=0％,OR=0.86,95％CI:0.66-1.12,P＞0.05).Conclusions Low-dose steroids therapy has no effect on short-term mortality of septicopyemia patients,but improves haemodynamics and prognosis of severe septicopyemia patients.ACTH stimulation test can not estimate the curative effect of steroid to septicopyemia.
