Efficacy and safety of low-dose hydrocortisone for the prevention and treatment of bronchopulmonary dysplasia in very premature infants： a meta-analysis

SHI Huiling; JIA Yanping; REN Yi

doi:10.6039/j.issn.1001-0408.2023.10.19

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Efficacy and safety of low-dose hydrocortisone for the prevention and treatment of bronchopulmonary dysplasia in very premature infants： a meta-analysis

更新时间：2023-05-25

- Efficacy and safety of low-dose hydrocortisone for the prevention and treatment of bronchopulmonary dysplasia in very premature infants： a meta-analysis
- ZHONGGUO YAOFANG Vol. 34, Issue 10, Pages: 1252-1256(2023)
- 作者机构：
  
  1.海口市妇幼保健院儿童保健部，海口　570203
  2.海口市妇幼保健院新生儿科，海口　570203
  3.海口市妇幼保健院儿内科，海口　570203
- 作者简介：
- 基金信息：
- DOI：10.6039/j.issn.1001-0408.2023.10.19
  CLC： R974;R722.6
- Published：30 May 2023，
  
  Received：25 August 2022，
  
  Revised：06 March 2023，
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施慧玲,贾雁平,任翼.小剂量氢化可的松防治极早产儿支气管肺发育不良有效性和安全性的Meta分析 ^Δ[J].中国药房,2023,34(10):1252-1256.

SHI Huiling,JIA Yanping,REN Yi.Efficacy and safety of low-dose hydrocortisone for the prevention and treatment of bronchopulmonary dysplasia in very premature infants： a meta-analysis[J].ZHONGGUO YAOFANG,2023,34(10):1252-1256.
施慧玲,贾雁平,任翼.小剂量氢化可的松防治极早产儿支气管肺发育不良有效性和安全性的Meta分析 ^Δ[J].中国药房,2023,34(10):1252-1256. DOI： 10.6039/j.issn.1001-0408.2023.10.19.

SHI Huiling,JIA Yanping,REN Yi.Efficacy and safety of low-dose hydrocortisone for the prevention and treatment of bronchopulmonary dysplasia in very premature infants： a meta-analysis[J].ZHONGGUO YAOFANG,2023,34(10):1252-1256. DOI： 10.6039/j.issn.1001-0408.2023.10.19.

摘要

目的

系统评价极早产儿早期预防性使用小剂量氢化可的松（HC）防治支气管肺发育不良（BPD）的有效性和安全性，为临床治疗提供循证参考。

方法

计算机检索PubMed、Embase、Web of Science、Cochrane图书馆、中国期刊全文数据库、中文科技期刊数据库、万方数据，收集极早产儿早期预防性使用小剂量HC（试验组）对比安慰剂或多巴胺（对照组）的随机对照试验（RCT）。检索时限均为建库起至2022年6月。筛选文献、提取资料后采用Cochrane系统评价员手册推荐的6.2偏倚风险评估工具对纳入文献质量进行评价；采用RevMan 5.3软件进行Meta分析、敏感性分析和发表偏倚分析。

结果

共纳入9篇RCT，总计1 437例极早产儿。Meta分析结果显示，试验组患儿的BPD发生率[OR＝0.75，95%CI（0.58，0.95），

＝0.02]、病死率[OR＝0.72，95%CI（0.54，0.97），

＝0.03]均显著低于对照组，无BPD生存率[OR＝1.36，95%CI（1.06，1.74），

＝0.02]、胃肠道穿孔发生率[OR＝2.23，95%CI（1.31，3.78），

＝0.003]、败血症发生率[OR＝1.27，95%CI（1.01，1.60），

＝0.04]均显著高于对照组；两组患儿的坏死性小肠结肠炎、脑室旁白质软化、脑室内出血、动脉导管未闭、高血糖、气胸、早产儿视网膜病发生率比较，差异均无统计学意义（

＞0.05）。敏感性分析结果显示，所得结果稳健。发表偏倚分析结果显示，本研究存在发表偏倚的可能性较小。

结论

极早产儿早期预防性使用小剂量HC可减少BPD的发生，降低病死率，提高无BPD生存率，但需注意胃肠道穿孔和败血症的发生。

Abstract

OBJECTIVE

To systematically evaluate the efficacy and safety of prophylactic use of low-dose hydrocortisone （HC） for the prevention and treatment of bronchopulmonary dysplasia （BPD）， and to provide evidence-based reference for clinical treatment.

METHODS

PubMed， Embase， Web of Science， Cochrane Library， CJFD， VIP and Wanfang databases were searched by computer； randomized controlled trials （RCT） about prophylactic use of low-dose HC （trial group） versus placebo or dopamine （control group） in very premature infants were collected from the establishment of the database to Jun. 2022. The quality of the included literature was evaluated by using bias risk assessment tool recommended by Cochrane system evaluator’s manual （version 6.2） after screening the literature and extracting the data. Meta-analysis， sensitivity analysis and publication bias analysis were carried out with RevMan 5.3 statistical software.

RESULTS

A total of 1 437 very premature infants were included in 9 RCTs. Meta-analysis showed that the incidence of BPD [OR＝0.75， 95%CI（0.58，0.95），

＝0.02] and fatality [OR＝0.72， 95%CI （0.54，0.97），

＝0.03] in trial group were significantly lower than control group； the survival rate without BPD [OR＝1.36， 95%CI （1.06，1.74），

＝0.02]， the incidences of gastrointestinal perforation [OR＝2.23， 95%CI （1.31，3.78），

＝0.003] and sepsis [OR＝1.27， 95%CI （1.01，1.60），

＝0.04] in trial group were all significantly higher than control group. There was no significant difference in the incidence of necrotizing enterocolitis， paraventricular leukomalacia， intraventricular hemorrhage， patent ductus arteriosus， hyperglycemia， pneumothorax， retinopathy of premature infants between the two groups （

＞0.05）. Results of sensitivity analysis showed that study results were robust. Results of publication bias analysis showed that there was little possibility of publication bias in this study.

CONCLUSIONS

The early prophylactic use of low-dose HC can reduce BPD in very premature infants， reduce fatality， and improve the survival rate without BPD， but we should pay attention to gastrointestinal perforation and sepsis.

关键词

极早产儿氢化可的松支气管肺发育不良有效性安全性Meta分析

Keywords

hydrocortisonebronchopulmonary dysplasiaefficacysafetymeta-analysis

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