脑脊液置换加鞘注异烟肼及地塞米松在结核性脑膜炎治疗中的价值—荟萃分析
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摘要
目的：通过荟萃分析的手段,观察脑脊液置换加鞘注疗法结合传统内科抗结核治疗和单纯传统内科抗结核治疗相比,具有什么样的优势和特点,探索其在结核性脑膜炎治疗中的价值,为进一步完善结核性脑膜炎的治疗方案提供依据。
材料和方法：计算机检索中国期刊全文数据库、Pubmed、Cochrane协作网、SCI数据库,记录符合条件的随机对照试验,根据纳入标准、排除标准、方法学评价等进一步筛选,最后使用荟萃分析的方法综合评价干预组(脑脊液置换加鞘注结合传统内科治疗)和对照组(单纯内科治疗)的治愈率、病死率、后遗症率,并比较不良反应的发生情况。统计软件采用Review Manager5.0,二分类变量采用相对危险度(RR)及其95%可信区间(CI)进行评估。异质性检验采用x2检验,如P≥0.05且I2≤50%,则采用固定效应模型,否则使用随机效应模型或亚组分析。
结果：共有16篇文献入选,发表年份范围2001至2010年,共1108名患者参与本分析,其中干预组580人,对照组528人。通过荟萃分析得到的结果可以看到,干预组比对照组具有更高的治愈率(RR=1.41,95%CI为1.27—1.57,P<0.00001)、更低的病死率(RR=0.37,95%CI为0.2—0.67,P=0.001)、更低的后遗症率(RR=0.65,95%CI为0.49—0.86,P=0.003),但也有一些不良反应发生。
结论：脑脊液置换合并鞘内注射异烟肼及地塞米松疗法,在结核性脑膜炎的治疗中的确有一定价值,能改善患者的治愈率,降低病死率,减少后遗症发生,在重症结核性脑膜炎患者中,有着良好的应用前景。
Objectives:Observe the advantages and characteristics of adjunctive cerebrospinal fluid replacement plus intrathecal isoniazid and dexamethasone therapy in the treatment of tuberculous meningitis compared with traditional therapy alone by the means of meta-analysis. Determine the value of this adjunctive therapy and provide evidence to make the treatment of tuberculous meningitis more optimal.
Materials and Methods:We searched the Chinese Journal Full-text Database, Pubmed Database, Cochrane Collaboration Database, and SCI Database for RCTs that compared adjunctive cerebrospinal fluid replacement plus intrathecal isoniazid and dexamethasone therapy with traditional therapy alone in the patients with tuberculous meningitis. The RCTs were filtered by inclusion and exclusion criteria, and the qualities were evaluated. Meta-analysis was made to compare the cure rate, mortality rate, and sequelae rate. The adverse events were also recorded. Review Manager5.0was used to do the meta-analysis. The results were presented by RR and95%CI form for dichotomous data, x2test was used for heterogeneity tests. If P≥0.05and I2≤50%, fixed effect model was applied. Otherwise random effect model or subgroup analysis would be used.
Results:Sixteen articles published from2001to2010, including1108patients with580in the observe group and528in the control group, were eligible. Higher cure rate (RR=1.41,95%CI1.27—1.57, P<0.00001), lower mortality rate (RR=0.37,95%CI0.2—0.67, P=0.001), and lower sequelae rate (RR=0.65,95%CI0.49—0.86, P=0.003) were achieved by the adjunctive cerebrospinal fluid replacement plus intrathecal isoniazid and dexamethasone group. But some adverse events had also been observed.
Conclusions:The use of adjunctive cerebrospinal fluid replacement plus intrathecal isoniazid and dexamethasone therapy results in higher cure rate, lower mortality rate, and less sequelaes. This therapy is effective for patients with tuberculous meningitis, especially late stage tuberculous meningitis.
材料和方法：计算机检索中国期刊全文数据库、Pubmed、Cochrane协作网、SCI数据库,记录符合条件的随机对照试验,根据纳入标准、排除标准、方法学评价等进一步筛选,最后使用荟萃分析的方法综合评价干预组(脑脊液置换加鞘注结合传统内科治疗)和对照组(单纯内科治疗)的治愈率、病死率、后遗症率,并比较不良反应的发生情况。统计软件采用Review Manager5.0,二分类变量采用相对危险度(RR)及其95%可信区间(CI)进行评估。异质性检验采用x2检验,如P≥0.05且I2≤50%,则采用固定效应模型,否则使用随机效应模型或亚组分析。
结果：共有16篇文献入选,发表年份范围2001至2010年,共1108名患者参与本分析,其中干预组580人,对照组528人。通过荟萃分析得到的结果可以看到,干预组比对照组具有更高的治愈率(RR=1.41,95%CI为1.27—1.57,P<0.00001)、更低的病死率(RR=0.37,95%CI为0.2—0.67,P=0.001)、更低的后遗症率(RR=0.65,95%CI为0.49—0.86,P=0.003),但也有一些不良反应发生。
结论：脑脊液置换合并鞘内注射异烟肼及地塞米松疗法,在结核性脑膜炎的治疗中的确有一定价值,能改善患者的治愈率,降低病死率,减少后遗症发生,在重症结核性脑膜炎患者中,有着良好的应用前景。
Objectives:Observe the advantages and characteristics of adjunctive cerebrospinal fluid replacement plus intrathecal isoniazid and dexamethasone therapy in the treatment of tuberculous meningitis compared with traditional therapy alone by the means of meta-analysis. Determine the value of this adjunctive therapy and provide evidence to make the treatment of tuberculous meningitis more optimal.
Materials and Methods:We searched the Chinese Journal Full-text Database, Pubmed Database, Cochrane Collaboration Database, and SCI Database for RCTs that compared adjunctive cerebrospinal fluid replacement plus intrathecal isoniazid and dexamethasone therapy with traditional therapy alone in the patients with tuberculous meningitis. The RCTs were filtered by inclusion and exclusion criteria, and the qualities were evaluated. Meta-analysis was made to compare the cure rate, mortality rate, and sequelae rate. The adverse events were also recorded. Review Manager5.0was used to do the meta-analysis. The results were presented by RR and95%CI form for dichotomous data, x2test was used for heterogeneity tests. If P≥0.05and I2≤50%, fixed effect model was applied. Otherwise random effect model or subgroup analysis would be used.
Results:Sixteen articles published from2001to2010, including1108patients with580in the observe group and528in the control group, were eligible. Higher cure rate (RR=1.41,95%CI1.27—1.57, P<0.00001), lower mortality rate (RR=0.37,95%CI0.2—0.67, P=0.001), and lower sequelae rate (RR=0.65,95%CI0.49—0.86, P=0.003) were achieved by the adjunctive cerebrospinal fluid replacement plus intrathecal isoniazid and dexamethasone group. But some adverse events had also been observed.
Conclusions:The use of adjunctive cerebrospinal fluid replacement plus intrathecal isoniazid and dexamethasone therapy results in higher cure rate, lower mortality rate, and less sequelaes. This therapy is effective for patients with tuberculous meningitis, especially late stage tuberculous meningitis.
引文
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