摘要
目的系统评价异烟肼联合地塞米松鞘内注射治疗结核性脑膜炎的临床疗效。方法本研究系统检索了PubMed、Embase、Cochrane Library及Web of Science等英文数据库,以及中国知网、万方数据和维普数据库等中文数据库,检索时间范围为各数据库建库至2024年4月,旨在收集关于异烟肼联合地塞米松鞘内注射治疗结核性脑膜炎的临床随机对照试验。采用Cochrane偏倚风险评估工具对纳入研究的质量进行严格评价,并运用Review Manager 5.3软件进行Meta分析,以确保研究结果的科学性和可靠性。结果本研究共纳入9篇文献,涉及678例患者。Meta分析结果显示,鞘内注射组与非鞘内注射组在临床治疗有效率上存在显著差异(RR=1.30,95%CI:1.21~1.41),鞘内注射组的临床治疗有效率显著高于非鞘内注射组;两组在不良事件发生率上也存在显著差异(RR=0.51,95%CI:0.33~0.78),非鞘内注射组的不良事件发生率显著高于鞘内注射组。此外,鞘内注射组在降低脑脊液蛋白质水平方面效果更为显著(MD=-0.64,95%CI:-0.83~-0.44),而在脑脊液葡萄糖水平的变化上,两组差异无统计学意义(MD=0.07,95%CI:-0.13~0.27)。鞘内注射组在升高脑脊液氯化物水平(MD=6.44,95%CI:1.59~11.29)和降低脑脊液白细胞数(MD=-26.99,95%CI:-48.98~-5.00)方面均表现出显著优势。结论常规药物治疗加异烟肼联合地塞米松鞘内注射治疗结核性脑膜炎的临床治疗有效率高于单纯常规治疗方案,且不良事件发生率较低。
Objective To systematically evaluate the clinical efficacy of intrathecal injection of isoniazid combined with dexamethasone in the treatment of tuberculous meningitis(TBM).Methods A comprehensive search was conducted in English databases,including PubMed,Embase,the Cochrane Library,and Web of Science,as well as Chinese databases such as CNKI,Wanfang Data,and VIP Database.The search time frame spanned from the establishment of each database to April 2024,focusing on clinical randomized controlled trials investigating the efficacy of intrathecal injection of isoniazid combined with dexamethasone for the treatment of tuberculous meningitis.The Cochrane Risk of Bias tool was used to assess the methodological quality of the included studies.Meta-analysis was performed using Review Manager 5.3 software to ensure the scientific validity and reliability of the findings.Results A total of 9 studies involving 678 patients were included in this meta-analysis.The results demonstrated a statistically significant difference in clinical efficacy between the intrathecal injection group and the non-intrathecal injection group(RR=1.30,95%CI:1.21-1.41),with the intrathecal injection group showing significantly higher clinical efficacy.Additionally,a significant difference was observed in the incidence of adverse events(RR=0.51,95%CI:0.33-0.78),with the non-intrathecal injection group exhibiting a higher incidence of adverse events.Furthermore,the intrathecal injection group was more effective in reducing protein levels of cerebrospinal fluid(MD=-0.64,95%CI:-0.83 to-0.44).However,no significant difference was found in the change of glucose levels of cerebrospinal fluid between the two groups(MD=0.07,95%CI:-0.13 to 0.27).The intrathecal injection group also showed significant improvements in elevating chloride levels of cerebrospinal fluid(MD=6.44,95%CI:1.59-11.29)and reducing white blood cell counts of cerebrospinal fluid(MD=-26.99,95%CI:-48.98 to-5.00).Conclusions The combination of conventional drug therapy with intrathecal injection of isoniazid and dexamethasone in the treatment of TBM results in a higher clinical treatment efficacy compared to conventional therapy alone,with a lower incidence of adverse events.
作者
辛明明
马序竹
林明贵
Xin Mingming;Ma Xuzhu;Lin Minggui(Department of Infectious Diseases,Beijing Tsinghua Changgung Hospital,School of Clinical Medicine,Tsinghua Medicine,Tsinghua University,Beijing 102218,China)
出处
《国际流行病学传染病学杂志》
2025年第3期195-203,共9页
International Journal of Epidemiology and Infectious Disease
