摘要
目的系统评价糖皮质激素辅助抗生素治疗儿童化脓性关节炎(septic arthritis,SA)的疗效。方法检索2003年7月至2016年3月,万方、CNKI、CBM、Pub Med、Cochrane Library及EMBASE等数据库关于糖皮质激素辅助抗生素治疗儿童SA疗效的临床对照研究(clinical controlled trial,CCT),由2名系统评价员及1名仲裁员进行文献筛查、文献质量评价和文献资料提取。通过临床和实验室指标评价糖皮质激素辅助抗生素治疗儿童SA的疗效。采用Revman 5.3软件进行Meta分析。结果共检索到246篇文献,筛选后纳入随机对照试验(randomized controlled trial,RCT)2篇,非随机对照试验(non-randomized controlled trial,NRCT)1篇及回顾性队列研究1篇,总样本量为348例,所有的研究均未报道糖皮质激素应用所导致的不良反应。Meta分析结果:糖皮质激素组可缩短住院天数[MD=-2.97,95%CI(-3.53,-2.41),P<0.05],可缩短静脉应用抗生素天数[MD=-3.59,95%CI(-4.82,-2.36),P<0.05],可缩短序贯口服抗生素天数[MD=-1.66,95%CI(-2.54,-0.78),P<0.05],同时加快C-反应蛋白(C-reactive protein,CRP)恢复正常[MD=-3.07,95%CI(-3.36,-2.79),P<0.05]。结论糖皮质激素辅助有效的抗生素治疗儿童SA可缩短住院天数、静脉应用抗生素天数及序贯口服抗生素天数,同时加快CRP恢复正常。
Objective To systematically assess the therapeutic effects of the adjunctive intravenous administration of corticosteroids in the treatment of children with septic arthritis（ SA）. Methods A meta-analysis was performed with data from clinical controlled trails（ CCT） retrieved in Wanfang, CNKI, CBM, Pub Med, Cochrane Library and EMBASE databases, Which were published from July 2003 to March 2016, with adjunctive corticosteroids in the treatment of children with SA focused on. Literature screening, quality assessment and extraction were done by 2 evaluators and an arbitrator. Evaluation of the therapeutic effects of the adjunctive treatment of corticosteroids on children with SA was carried out, which included clinical data and laboratory tests. Statistical analysis was performed using the software Rev Man 5.3. Results A total of 246 articles were retrieved. Two articles on randomized controlled trials（ RCTs）, one on non-randomized controlled trial（ NRCT） and one on retrospective cohort study met our criteria. The total sample size was 348. No side effects of corticosteroids as adjunctive treatment were reported. The metaanalysis showed that corticosteroids might shorten the days of hospitalization [ MD =-2.97, 95% CI（-3.53,-2.41）,P〈0.05 ], the days of intravenous antibiotics treatment [ MD =-3.59, 95% CI（-4.82,-2.36）, P〈0.05 ] and the days of oral antibiotics treatment [ MD =-1.66, 95% CI（-2.54,-0.78）, P〈0.05 ]. For the children with SA who received corticosteroids as an adjunctive treatment, C-reactive protein（ CRP） might fall back to the normal level in a faster manner [ MD =-3.07, 95% CI（-3.36,-2.79）, P〈0.05 ]. Conclusions The adjunctive administration of corticosteroids is beneficial to the treatment of SA in children. This therapy can shorten the days of hospitalization and the days of intravenous and oral antibiotics treatment. It can also accelerate the recovery of CRP.
出处
《中国骨与关节杂志》
CAS
2017年第1期57-62,共6页
Chinese Journal of Bone and Joint
基金
国家自然科学基金面上项目(81272022)
