摘要
目的 系统评价糖皮质激素治疗重症新型冠状病毒肺炎(COVID-19)的有效性和安全性,以期为重症COVID-19患者的治疗策略提供参考依据。方法 计算机检索PubMed、EMbase、The Cochrane Library、Web of Science、ClinicalTrials.gov、WanFang Data和CNKI数据库,搜集糖皮质激素治疗重症COVID-19相关的随机对照试验,检索时限均从建库至2021年8月26日。由2位评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果 共纳入7个研究,包括6 236例患者。Meta分析结果显示:与常规治疗相比,糖皮质激素治疗重症COVID-19在降低全因死亡率[RR=0.84,95%CI(0.77,0.91),P<0.000 1]方面,两组差异有统计学意义;但在复合疾病进展[RR=0.84,95%CI(0.69,1.01),P=0.06]方面,两组差异无统计学意义。与常规治疗相比,糖皮质激素并不增加重症患者不良反应[一般不良反应:RR=1.15,95%CI(0.66,2.03),P=0.62;严重不良反应:RR=1.13,(95%CI(0.54,2.38),P=0.75)]。结论 现有证据表明,糖皮质激素治疗重症COVID-19有效,且未明显增加不良反应。受纳入研究数量和质量限制,上述结论尚需开展更多高质量研究予以验证。
Objective To systematically review the efficacy and safety of glucocorticoids for severe COVID-19and to provide references for the treatment strategy of severe COVID-19 patients. Methods PubMed, EMbase, The Cochrane Library, Web of Science, ClinicalTrials.gov, WanFang Data and CNKI databases were electronically searched to collect randomized controlled trials(RCTs) that reported glucocorticoid therapy for severe COVID-19 patients from inception to August 26th, 2021. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed using RevMan 5.3 software. Results A total of 7 RCTs involving 6 236 patients were included. The meta-analysis results showed that compared with usual care, glucocorticoids significantly reduced the all-cause mortality of severe COVID-19(RR=0.84, 95%CI 0.77 to 0.91, P<0.000 1), whereas no significant difference was found in the progression of complex diseases between the two groups(RR=0.84, 95%CI 0.69 to1.01, P=0.06). Glucocorticoids did not increase adverse effects in severe COVID-19 compared with usual care(general adverse events: RR=1.15, 95%CI 0.66 to 2.03, P=0.62;serious adverse events: RR=1.13, 95%CI 0.54 to 2.38, P=0.75).Conclusion Current evidence suggests that glucocorticoids are effective in treating severe COVID-19 without significantly increasing adverse events. However, due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the conclusion.
作者
刘敏
杨程
冯春露
庹琳
耿晓霞
杨兴祥
LIU Min;YANG Cheng;FENG Chunlu;TUO Lin;GENG Xiaoxia;YANG Xingxiang(Chengdu Medical College,Chengdu 610500,P.R.China;Department of Infectious Disease,Sichuan Academy of Medical Sciences·Sichuan Provincial People's Hospital,Chengdu 610072,P.R.China;School of Medicine,University of Electronic Science and Technology of China,Chengdu 610054,P.R.China)
出处
《中国循证医学杂志》
CSCD
北大核心
2022年第4期387-393,共7页
Chinese Journal of Evidence-based Medicine
基金
四川省卫生健康委员会医学重大创新项目(编号:20ZDCX002)。
