CDSR:糖皮質激素對結核性腦膜炎的作用

2016年5月6日訊/生物谷BIOON/--近期，一組研究人員對抗結核藥物與糖皮質激素聯合治療患有結核性腦膜炎的效果進行了評估。

結核性腦膜炎是一種嚴重的結核病(TB)，它會影響覆蓋大腦和脊髓的膜。病毒感染會引起頭痛、昏迷和死亡。倖存者也會存在腦損傷殘疾的風險。

糖皮質激素通常與抗結核藥物聯合使用來治療結核性腦膜炎患者。皮質激素有助於減少大腦和周圍血管的炎症，也可減少對大腦的壓力和死亡的人數。然而，有一些臨床醫生擔憂，儘管糖皮質激素可能會改善生存狀況，但倖存者們更有可能會嚴重殘疾。

研究人員進行了九個試驗，總共有1337人參與，他們評估了地塞米松、甲基強的松龍或氫化潑尼松與抗結核藥物共同作用的效果。

研究者發現經過兩個月到兩年糖皮質激素的治療時期後，降低了四分之一的死亡風險。該項試驗對參與者隨訪五年，這段時間內糖皮質激素組和對照組之間死亡率的影響沒有區別；然而這種隨時間變化的原因是未知的。這項試驗還研究了糖皮質激素對愛滋病病毒試驗呈陽性的人的影響，但是一小部分包含參與者認為研究者不確定是否該組參與者的死亡率有所降低。

Hannah Ryan博士說：「證據清楚地表明了類固醇可減少四分之一的死亡。估計嚴重殘疾程度不是很準確，因為它很罕見，但即使是最悲觀的統計估計試驗也告訴我們，類固醇的益處是其產生死亡率遠遠小於患者殘疾率。」（生物谷Bioon.com）

本文系生物谷原創編譯整理，歡迎轉載！點擊 獲取授權 。更多資訊請下載生物谷APP.

 

Corticosteroids for managing tuberculous 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.