中国神经再生研究(英文版)

中国神经再生研究(英文版) ›› 2014, Vol. 9 ›› Issue (6): 637-645.doi: 10.4103/1673-5374.130085

• 原著:脑损伤修复保护与再生 • 上一篇    下一篇

早产儿应用地塞米松对智力与听力影响的meta分析

  

  • 收稿日期:2014-01-28 出版日期:2014-03-22 发布日期:2014-03-22
  • 基金资助:

    湖南省科技计划项目课题资助(No. 2011SK3234)

Effect of dexamethasone on intelligence and hearing in preterm infants: a meta-analysis

Ruolin Zhang, Tao Bo, Li Shen, Senlin Luo, Jian Li   

  1. Department of Pediatrics, Second Xiangya Hospital, Central South University, Changsha, Hunan Province, China
  • Received:2014-01-28 Online:2014-03-22 Published:2014-03-22
  • Contact: Jian Li, M.D., Department of Pediatrics, Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China, juli0802@sina.com.

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摘要：

目的：应用meta分析方法对已发表有关地塞米松对早产儿神经系统发育长期影响的随机对照实验进行综合定量分析。
资料来源：以早产儿、地塞米松为主题词，通过计算机检索The Cochrane图书馆(1993-01/2013-06)、EMBASE(1980-01/2013-06)、MEDLINE (1963-01/2013-06)、OVID(1993-01/2013-06)、Springer(1994-01/2013-06)数据库和中国期刊全文数据库(1994-01/2013-06)。
资料选择：纳入所有关于早产儿静脉应用地塞米松的随机对照实验，对符合要求的文献进行质量评估，排除未描述神经系统发育损伤及动物实验的文献。文献质量评价根据Cochrane协作网Cocharane评价手册5.1.0进行偏倚风险评价。对同质研究采用Revman 5.2.6软件对结果进行合并统计分析, 根据异质性结果选择相应的效应模型分析；对无法进行meta分析的文献采用描述性分析。
结局评价指标：早产儿神经系统发育损伤情况。
结果：共纳入10篇随机对照实验，总样本量为1 038例，其中地塞米松干预组512例，安慰剂对照组及空白对照组526例。meta分析结果显示，早产儿早期（生后7 d内）应用地塞米松后，脑瘫、视觉损害以及听力损害的发生率与对照组相近(RR=1.47，95% CI：0.97-2.21；RR=1.46，95% CI：0.97-2.20; RR=0.80，95% CI：0.54-1.18；P > 0.05)，智商值较对照组显著性降低(MD=-3.55，95%CI：-6.59- -0.51；P=0.02)。早产儿晚期（生后7 d以后）应用地塞米松后，脑瘫、视觉损伤的发生率以及智商值的高低较对照组相近(RR=1.26，95%CI: 0.89-1.79；RR=1.37，95%CI: 0.73-2.59；RR=0.53，95%CI：0.32-0.89; 1.66，95%CI: -4.7-8.01；P>0.05)，听力损伤的发生率干预组较对照组显著增高(RR=0.53，95%CI: 0.32-0.89；P=0.02)。
结论：早产儿早期应用地塞米松可能智商损害程度较大，而晚期应用后听力损伤的发生率可能更大，但更可靠结论尚需大样本、多中心、设计良好的随机对照试验进一步验证。

关键词: 神经再生, 系统综述, 早产儿, 地塞米松, 糖皮质激素, 神经系统发育, 脑瘫, 听力损害, meta分析, 随机对照实验

Abstract:

OBJECTIVE: A meta-analysis of published randomized controlled trials investigating the long-term effect of dexamethasone on the nervous system of preterm infants.
DATA SOURCES: Online literature retrieval was conducted using The Cochrane Library (from January 1993 to June 2013), EMBASE (from January 1980 to June 2013), MEDLINE (from January 1963 to June 2013), OVID (from January 1993 to June 2013), Springer (from January 1994 to June 2013) and Chinese Academic Journal Full-text Database (from January 1994 to June 2013). Key words were preterm infants and dexamethasone in English and Chinese.
STUDY SELECTION: Selected studies were randomized controlled trials assessing the effect of intravenous dexamethasone in preterm infants. The quality of the included papers was evaluated and those without the development of the nervous system and animal experiments were excluded. Quality assessment was performed through bias risk evaluation in accordance with Cochrane Handbook 5.1.0 software in the Cochrane Collaboration. The homogeneous studies were analyzed and compared using Revman 5.2.6 software, and then effect model was selected and analyzed. Those papers failed to be included in the meta-analysis were subjected to descriptive analysis.
MAIN OUTCOME MEASURES: Nervous system injury in preterm infants.
RESULTS: Ten randomized controlled trials were screened, involving 1,038 subjects. Among them 512 cases received dexamethasone treatment while 526 cases served as placebo control group and blank control group. Meta-analysis results showed that the incidence of cerebral palsy, visual impairment and hearing loss in preterm infants after dexamethasone treatment within 7 days after birth was similar to that in the control group (RR = 1.47, 95%CI: 0.97–2.21; RR = 1.46, 95%CI: 0.97–2.20; RR = 0.80, 95%CI: 0.54–1.18; P > 0.05), but intelligence quotient was significantly decreased compared with the control group (MD = −3.55, 95%CI: −6.59 to −0.51; P = 0.02). Preterm infants treated with dexamethasone 7 days after birth demonstrated an incidence of cerebral palsy and visual impairment, and changes in intelligence quotient similar to those in the control group (RR = 1.26, 95%CI: 0.89–1.79; RR = 1.37, 95%CI: 0.73–2.59; RR = 0.53, 95%CI: 0.32–0.89; RR = 1.66, 95%CI: −4.7 to 8.01; P > 0.05). However, the incidence of hearing loss was significantly increased compared with that in the control group (RR = 0.53, 95%CI: 0.32–0.89; P = 0.02).
CONCLUSION: Dexamethasone may affect the intelligence of preterm infants in the early stages after birth, but may lead to hearing impairment at later stages after birth. More reliable conclusions should be made through large-size, multi-center, well-designed randomized controlled trials.

Key words: nerve regeneration, systematic review, preterm infants, dexamethasone, glucocorticoids, nervous system development, cerebral palsy, hearing impairment, meta-analysis, randomized controlled trials, the Science and Technology Plan Program of Hunan Province, neural regeneration