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[大学生论坛]:治疗咽喉痛的皮质类固醇:随机试验的系统评价和荟萃分析

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灯光下的小人物 发表于 2017-12-30 21:36:47 | 显示全部楼层 |阅读模式
Corticosteroidsfor treatment of sore throat: systematic review and meta-analysis of randomisedtrials
治疗咽喉痛的皮质类固醇:随机试验的系统评价和荟萃分析
BMJ 2017; 358 doi: https://doi.org/10.1136/bmj.j3887 (Published 20 September 2017)Cite this as: BMJ 2017;358:j3887
Abstract
摘要:
Objective To estimate the benefits and harmsof using corticosteroids as an adjunct treatment for sore throat.
目标:评估使用皮质类固醇作为喉咙痛辅助治疗的益处和危害。
Design Systematic review and meta-analysisof randomised control trials.
研究设计:随机对照试验的系统评价和荟萃分析。
Datasources Medline, Embase, Cochrane Central Register of Controlled Trials(CENTRAL), trial registries up to May 2017, reference lists of eligible trials,related reviews.
数据源:美国医学索引,荷兰医学文摘,在Cochrane对照试验中心注册库(中央),至2017年5月的试验注册,符合条件的试验得到参考文献目录,相关的评估。
Studyselection Randomised controlled trials of the addition of corticosteroidsto standard clinical care for patients aged 5 or older in emergency departmentand primary care settings with clinical signs of acute tonsillitis,pharyngitis, or the clinical syndrome of sore throat. Trials were includedirrespective of language or publication status.
资料选择:进行随机对照试验,对在急诊科和初级保健机构的具有急性扁桃体炎,咽炎或咽喉炎临床症状的5岁及以上患者的标准临床护理中加用皮质激素。试验不考虑语言和出版状态。
Reviewmethods Reviewers identified studies, extracted data, and assessed thequality of the evidence, independently and in duplicate. A parallel guidelinecommittee (BMJ Rapid Recommendation) provided input on the design andinterpretation of the systematic review, including the selection of outcomesimportant to patients. Random effects model was used for meta-analyses. Qualityof evidence was assessed with the GRADE approach.
分析方法:审稿人独立地,一式两份地确定研究,提取数据并评估证据的质量。 平行指南委员会(BMJ Rapid Recommendation)为系统评价的设计和解释提供了信息,包括选择对患者重要的结果。 随机效应模型被用于荟萃分析。 用GRADE方法评估证据的质量。
Results 10 eligible trials enrolled 1426individuals. Patients who received single low dose corticosteroids (the mostcommon intervention was oral dexamethasone with a maximum dose of 10 mg) weretwice as likely to experience pain relief after 24 hours (relative risk 2.2,95% confidence interval 1.2 to 4.3; risk difference 12.4%; moderate qualityevidence) and 1.5 times more likely to have no pain at 48 hours (1.5, 1.3 to1.8; risk difference 18.3%; high quality). The mean time to onset of pain reliefin patients treated with corticosteroids was 4.8 hours earlier (95% confidenceinterval −1.9 to −7.8; moderate quality) and the mean time to completeresolution of pain was 11.1 hours earlier (−0.4 to −21.8; low quality) than inthose treated with placebo. The absolute pain reduction at 24 hours (visualanalogue scale 0-10) was greater in patients treated with corticosteroids (meandifference 1.3, 95% confidence interval 0.7 to 1.9; moderate quality). Nine ofthe 10 trials sought information regarding adverse events. Six studies reportedno adverse effects, and three studies reported few adverse events, which weremostly complications related to disease, with a similar incidence in bothgroups.
结果:10个符合条件的试验招募了1426个人。接受单一低剂量皮质类固醇激素治疗(最常见的干预措施是口服地塞米松,最大剂量为10mg)的患者在24小时后可能出现疼痛缓解两倍(相对风险2.2,95%可信区间1.2-4.3;风险差异12.4 %;中等质量证据),在48小时内无疼痛的可能性是1.5倍(1.5,1.3至1.8;风险差异18.3%;高质量)。皮质类固醇激素治疗患者疼痛缓解的平均时间为4.8小时(95%置信区间为-1.9至-7.8;中等质量),完全缓解疼痛的平均时间为11.1小时(-0.4至-21.8 ;质量低)比安慰剂治疗。用皮质类固醇治疗的患者24小时的绝对疼痛减轻(视觉模拟评分0-10)更大(平均差1.3,95%可信区间0.7-1.9;中等质量)。 10个试验中有9个寻求有关不良事件的信息。六项研究报告没有不良反应,三项研究报告副作用很少,主要是与疾病相关的并发症,两组的发生率相似。
Conclusion Single low dosecorticosteroids can provide pain relief in patients with sore throat, with noincrease in serious adverse effects. Included trials did not assess thepotential risks of larger cumulative doses in patients with recurrent episodesof acute sore throat.
结论:低单次量皮质类固醇可以减轻喉咙痛患者的疼痛,同时不会增加不良反应的严重程度。 本研究包含的试验没有评估复发急性喉咙痛患者的累积剂量较大的潜在风险。
Systematic review registration PROSPEROCRD42017067808.
系统评价注册PROSPERO CRD42017067808
http://www.bmj.com/content/358/bmj.j3887

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