摘要
目的评估抗菌药物、糖皮质激素和静脉丙种球蛋白（IVIG）对儿童肺炎支原体感染的治疗价值。方法通过检索Cochrane图书馆、PubMed、万方、CNKI及维普数据库从建库至2015年7月的文献，按照纳入和排除标准筛选，提取纳入文献中的相关信息，采用JADAD评分对纳入的各项研究进行质量评价。对纳入文献中针对儿童肺炎支原体感染使用大环内酯类抗菌药物、糖皮质激素、IVIG的疗效进行循证分析。适宜条件的文献使用Cochrane协作网提供的RevMan5．3软件进行Meta分析，不适宜者则进行描述性分析。结果（1）大环内酯类抗菌药物治疗研究共纳入国外索引收录随机对照试验（RCT）文献7篇和国内索引收录RCT文献7篇。国外索引收录文献之间异质性较大，其中有5篇文献显示使用大环内酯类抗菌药物和非大环内酯类抗菌药物，临床疗效比较差异无统计学意义。选择指标齐全的国内索引文献，对退热时间和咳嗽持续时间进行森林图分析显示：阿奇霉素序贯疗法比红霉素静脉治疗，退热时间均数差为-1．10，95％可信区间（CI）：-1．60，-0．60；咳嗽持续时间均数差为-1．56，95％CI：-2．10，-1．03。（2）糖皮质激素治疗研究纳入国外索引收录的RCT文献3篇和国内索引收录的RCT文献5篇。所有文献JADAD评分均为1分，基础治疗药物均为大环内酯类药物。亚组分析结果显示：早期使用糖皮质激素组比未用糖皮质激素组，退热时间均数差为-1．77，95％CI：-2．44，-1．10；咳嗽持续时间均数差为-2．47，95％可信区间为（-2．86，-2．08）。病程10d后使用糖皮质激素组比未用糖皮质激素组，退热时间均数差为-3．41，95％C1：-4．10，-2．73；咳嗽持续时间均数差为-2．25，95％CI：-4．38，-0．12。（3）IVIG治疗均为病例分析或个案报道。主要集中在重症肺炎支原体感染、合并肺外并发症者，有限的结果倾向于IVIG可缩短病程，部分改善临床症状。结论抗菌药物治疗肺炎支原体感染疗效的确切证据需进-步充实，大环内酯类抗菌药物特别是阿奇霉素具有较好的退热和缓解咳嗽的作用。糖皮质激素辅助治疗对MP感染临床症状改善有效，而使用IVIG治疗尚处于探索阶段。
Objective To evaluate the therapeutic effects of antibacterial agents, glucocorticoid and intravenous immunoglobulin （IVIG） in treating Mycoplasma pneumoniae （MP） infections. Method The literature was screened by the inclusion and exclusion criteria after searching at Cochrane Library, Pubmed, Wanfang, CNKI, and Weipu databases. According to JADAD evaluation system, the relevant information in each included report from the literature was evaluated. The evidence-based analysis was performed for the therapeutic effects of macrolides, glucocorticoid, and IVIG in treating MP infections. Meta-analysis was conducted on the suitable literature by RevMan 5.3 software supplied by Cochrane collaboration. Descriptive analysis was conducted on the literature unsuitable for meta-analysis. Result （1） Seven foreign RCT reports and 7 domestic RCT reports were included in the analysis of the therapeutic effect of macrolides. There was a high heterogeneity among the 7 foreign reports. Five of these reports showed no significant difference in clinical effects between macrolides and non-macrolide antibacterial agents. The forest plot analysis of antipyretic timing and cough duration in the domestic literature with complete indicators suggested that for azithromycin sequential therapy vs. erythromycin intravenous therapy, the mean difference of antipyretic timing was - 1.10 （95% CI： - 1.60, -0.60） and the mean difference of cough duration was - 1.56 （95% CI： - 2.10, - 1.03 ）. （2） Three foreign RCT reports and 5 domestic RCT were included in the analysis of glucocorticoid therapy. The JADAD scores of all the reports were 1. The basic therapy drug was macrolides. The results of sub-group analysis suggested that for the patients who used glucocorticoid early vs. the patients who used non-glucocorticoid therapy, the mean difference of antipyretic time was - 1.77（95% CI： - 2.44, - 1.10） and the mean difference of cough duration was - 2.47 （95% CI： - 2. 86, - 2.08 ） ; for the patients treated with glucocorticoid at 10 days after onset of diseases vs. the patients received non-glucocorticoid therapy, the mean difference of antipyretic time was -3.41 （95% CI： - 4.10, - 2.73） and the mean difference of cough duration was - 2.25 （95% CI： - 4.38, - 0. 12）. （3） Regarding IVIG, all the included reports were case study or case report. Most of the literature focused on severe Mycoplasma pneumoniae infection and those with extrapulmonary complications. The limited results suggested a trend of the shortening of disease process and improvement of clinical symptoms by IVIG. Conclusion There was no exact evidence of the therapeutic effects of antibacterial agents in Mycoplasma pneumoniae infections. A trend of better therapeutic effect was inferred in macrolide antibiotics, especially azithromycin. The improvement of clinical symptoms was suggested with the usage of glucocorticoid as adiuvant therapy. IVIG as an adiuvant therapy is at an exoloration stage.
出处
《中华儿科杂志》
CAS
CSCD
北大核心
2016年第2期111-118,共8页
Chinese Journal of Pediatrics
关键词
肺炎支原体
感染
治疗学
儿童
循证分析
Mycoplasma pneumoniae,infections
Therapies
Child
Evidence-based analysis
