甲泼尼龙联合阿奇霉素与单用阿奇霉素治疗儿童难治性肺炎支原体肺炎有效性及安全性的Meta分析

Meta-Analysis of Efficacy and Safety of Methylprednisolone Combined with Azithromycin and Azithromycin Alone in the Treatment of Refractory Mycoplasma Pneumoniae Pneumonia in Children

摘要: 目的：探讨甲泼尼龙联合阿奇霉素治疗儿童难治性肺炎支原体肺炎的有效性及安全性。方法：检索Pubmed、Embase、Cochrane Library、Web of Science、知网、中国生物文献数据库、万方、维普数据库，检索截止日期为数据库建库至2023年10月，筛选探讨甲泼尼龙联合阿奇霉素治疗儿童难治性肺炎支原体肺炎疗效及安全性的随机对照试验(RCT)，选择符合纳排标准的文献进行Meta分析，使用RevMan 5.1软件处理数据。结果：本文最终纳入29篇文献，共计2538名患儿。Meta分析结果显示，联合使用甲泼尼龙和阿奇霉素较单用阿奇霉素能提高总有效率(RR = 1.24, 95%CI (1.19, 1.28), P < 0.001)。联合治疗能有效缩短退热时间(MD = −2.88, 95%CI (−3.18, −2.57), P < 0.001)及肺部体征持续时间(MD = −2.98, 95%CI (−3.49, −2.47), P < 0.001)，能更快促进肺部阴影吸收(MD = −4.15, 95%CI (−5.88, −2.42), P < 0.001)，缩短住院时长(MD = −3.60, 95%CI (−4.58, −2.62), P < 0.001)，明显降低CRP水平(MD = −15.35, 95%CI (−18.86, −11.84), P < 0.001)。同时，两组在不良反应发生率上无统计学差异(RR = 0.85, 95%CI (0.64, 1.12), P = 0.25 > 0.05)。结论：通过对现有文献的综合分析发现，甲泼尼龙联合阿奇霉素治疗儿童难治性肺炎支原体肺炎较单用阿奇霉素可以提高治疗有效性，且安全性良好。

Abstract: Objective: To explore the efficacy and safety of methylprednisolone combined with azithromycin in the treatment of refractory Mycoplasma pneumoniae pneumonia in children. Methods: PubMed, Embase, Cochrane Library, Web of Science, CNKI, CBM, Wanfang Database, and VIP Database were searched. The search time limit was built until October 2023. Randomized Controlled Trials (RCTs) of exploring the efficacy and safety of methylprednisolone combined with azithromycin in the treatment of children with refractory Mycoplasma pneumoniae pneumonia were included. Literature that met the criteria was selected for Meta-analysis, and RevMan 5.1 software was used to process the data. Results: 29 studies involving 2538 patients were finally included in this paper. Meta-analysis showed that the combination of methylprednisolone and azithromycin increased the overall efficacy rate compared with azithromycin alone (RR = 1.24, 95%CI (1.19, 1.28), P < 0.001). Combination therapy was effective in shortening the defervescence time (MD = −2.88, 95%CI (−3.18, −2.57), P < 0.001) and the duration of pulmonary signs (MD = −2.98, 95%CI (−3.49, −2.47), P < 0.001), faster promotion of the absorption of shadows in the lungs (MD = −4.15, 95%CI (−5.88, −2.42), P < 0.001), reduce hospitalization time (MD = −3.60, 95%CI (−4.58, −2.62), P < 0.001), and significantly decrease CRP levels (MD = −15.35, 95%CI (−18.86, −11.84), P = < 0.05). Meanwhile, there was no statistically significant difference between the two groups in the incidence of adverse reactions (RR = 0.85, 95%CI (0.64, 1.12), P = 0.25 > 0.05). Conclusions: A comprehensive analysis of the available literature revealed that methylprednisolone combined with azithromycin for the treatment of refractory Mycoplasma pneumoniae pneumonia in children can improve the treatment effectiveness and have a good safety compared with azithromycin alone.