CDSR:糖皮质激素对结核性脑膜炎的作用

我要评论 2016-05-06来源:生物谷作者:

2016年5月6日讯/生物谷BIOON/--近期,一组研究人员对抗结核药物与糖皮质激素联合治疗患有结核性脑膜炎的效果进行了评估。

结核性脑膜炎是一种严重的结核病(TB),它会影响覆盖大脑和脊髓的膜。病毒感染会引起头痛、昏迷和死亡。幸存者也会存在脑损伤残疾的风险。

糖皮质激素通常与抗结核药物联合使用来治疗结核性脑膜炎患者。皮质激素有助于减少大脑和周围血管的炎症,也可减少对大脑的压力和死亡的人数。然而,有一些临床医生担忧,尽管糖皮质激素可能会改善生存状况,但幸存者们更有可能会严重残疾。

研究人员进行了九个试验,总共有1337人参与,他们评估了地塞米松、甲基强的松龙或氢化泼尼松与抗结核药物共同作用的效果。

研究者发现经过两个月到两年糖皮质激素的治疗时期后,降低了四分之一的死亡风险。该项试验对参与者随访五年,这段时间内糖皮质激素组和对照组之间死亡率的影响没有区别;然而这种随时间变化的原因是未知的。这项试验还研究了糖皮质激素对艾滋病病毒试验呈阳性的人的影响,但是一小部分包含参与者认为研究者不确定是否该组参与者的死亡率有所降低。

Hannah Ryan博士说:“证据清楚地表明了类固醇可减少四分之一的死亡。估计严重残疾程度不是很准确,因为它很罕见,但即使是最悲观的统计估计试验也告诉我们,类固醇的益处是其产生死亡率远远小于患者残疾率。”

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doi: 10.1002/14651858.CD002244.pub4
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Corticosteroids for managing tUber target=_blank class=infotextkey>Uberculous meningitis.

Kameshwar Prasad, Mamta B Singh, Hannah Ryan

Background Tuberculous meningitis is a serious form of tuberculosis (TB) that affects the meninges that cover a person's brain and spinal cord. It is associated with high death rates and with disability in people who survive. Corticosteroids have been used as an adjunct to antituberculous drugs to treat people with tuberculous meningitis, but their role has been controversial. Objectives To evaluate the effects of corticosteroids as an adjunct to antituberculous treatment on death and severe disability in people with tuberculous meningitis. Search methods We searched the Cochrane Infectious Diseases Group Specialized Register up to the 18 March 2016; CENTRAL; MEDLINE; EMBASE; LILACS; and Current Controlled Trials. We also contacted researchers and organizations working in the field, and checked reference lists. Selection criteria Randomized controlled trials that compared corticosteroid plus antituberculous treatment with antituberculous treatment alone in people with clinically diagnosed tuberculous meningitis and included death or disability as outcome measures. Data collection and analysis We independently assessed search results and methodological quality, and extracted data from the included trials. We analysed the data using risk ratios (RR) with 95% confidence intervals (CIs) and used a fixed-effect model. We performed an intention-to-treat analysis, where we included all participants randomized to treatment in the denominator. This analysis assumes that all participants who were lost to follow-up have good outcomes. We carried out a sensitivity analysis to explore the impact of the missing data. Main results Nine trials that included 1337 participants (with 469 deaths) met the inclusion criteria. At follow-up from three to 18 months, steroids reduce deaths by almost one quarter (RR 0.75, 95% CI 0.65 to 0.87; nine trials, 1337 participants, high quality evidence). Disabling neurological deficit is not common in survivors, and steroids may have little or no effect on this outcome (RR 0.92, 95% CI 0.71 to 1.20; eight trials, 1314 participants, low quality evidence). There was no difference between groups in the incidence of adverse events, which included gastrointestinal bleeding, invasive bacterial infections, hyperglycaemia, and liver dysfunction.

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