用于儿童急性腹泻和急性肠胃炎治疗的有效性和安全性：系统评价与网状Meta分析方案
The effectiveness and safety of treatments used for acute diarrhea and acute gastroenteritis in children: protocol for a systematic review and network meta-analysis.
作者信息
Florez Ivan D, Al-Khalifah Reem, Sierra Javier M, Granados Claudia M, Yepes-Nuñez Juan J, Cuello-Garcia Carlos, Perez-Gaxiola Giordano, Zea Adriana M, Hernandez Gilma N, Veroniki Areti-Angeliki, Guyatt Gordon H, Thabane Lehana
机构信息
Department of Clinical Epidemiology & Biostatistics, McMaster University, Juravinski Site. G Wing, 2nd Floor; 711 Concession Street, Hamilton, ON, L8V 1 C3, Canada.
Department of Pediatrics, Universidad de Antioquia, Medellín, Colombia.
出版信息
Syst Rev. 2016 Jan 20;5:14. doi: 10.1186/s13643-016-0186-8.
BACKGROUND
Acute diarrhea and acute gastroenteritis (AD/AGE) are common among children in low- and middle-income countries (LMIC) and high-income countries (HIC). Supportive therapy including maintaining feeding, prevention of dehydration, and use of oral rehydration solution (ORS), is the mainstay of treatment in all children. Several additional treatments aiming to reduce the episode duration have been compared to placebo, but the differences in effectiveness among them are unknown.
METHODS AND ANALYSIS
We will conduct a systematic review of all randomized controlled trials evaluating the use of zinc, vitamin A, probiotics, prebiotics, synbiotics, racecadotril, smectite, and fermented and lactose-free milk/formula for AD/AGE treatment in children. The primary outcomes are diarrhea duration and mortality. Secondary outcomes are diarrhea lasting 3 or 7 days, stool frequency, treatment failure, hospitalizations, and adverse events. We will search MEDLINE, Ovid EMBASE, CINAHL, the Cochrane Central Register of Controlled Trials (CENTRAL), and LILACS through Ovid, as well as grey literature resources. Two reviewers will independently screen titles and abstracts, review full texts, extract information, and assess the risk of bias (ROB) and the confidence in the estimate (with the grading of recommendations, assessment, development, and evaluation [GRADE] approach). Results will be summarized narratively and statistically. Subgroup analysis according to HIC vs. LMIC, age, nutrition status, and ROB is planned. We will perform a Bayesian network meta-analysis to combine the pooled direct and indirect treatment effect estimates for each outcome, if adequate data is available.
DISCUSSION
This is the first systematic review and network meta-analysis that aims to determine the relative effectiveness of pharmacological and nutritional treatments for reducing the duration of AD/AGE in children. The results will help to reduce the uncertainty of the effectiveness of the interventions, find knowledge gaps, and/or encourage further research for other therapeutic options.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO registration number: CRD42015023778.
背景
急性腹泻和急性肠胃炎（AD/AGE）在低收入和中等收入国家（LMIC）以及高收入国家（HIC）的儿童中很常见。支持性治疗，包括维持喂养、预防脱水以及使用口服补液盐（ORS），是所有儿童治疗的主要手段。几种旨在缩短病程的额外治疗方法已与安慰剂进行了比较，但它们之间的有效性差异尚不清楚。
方法与分析
我们将对所有评估锌、维生素A、益生菌、益生元、合生元、消旋卡多曲、蒙脱石以及发酵和无乳糖牛奶/配方奶用于儿童AD/AGE治疗的随机对照试验进行系统评价。主要结局是腹泻持续时间和死亡率。次要结局是腹泻持续3天或7天、排便频率、治疗失败、住院情况以及不良事件。我们将通过Ovid搜索MEDLINE、Ovid EMBASE、CINAHL、Cochrane对照试验中心注册库（CENTRAL）以及LILACS，以及灰色文献资源。两名评价者将独立筛选标题和摘要、审查全文、提取信息，并评估偏倚风险（ROB）和估计的可信度（采用推荐分级、评估、制定和评价[GRADE]方法）。结果将进行描述性和统计学总结。计划根据高收入国家与低收入和中等收入国家、年龄、营养状况以及偏倚风险进行亚组分析。如果有足够的数据，我们将进行贝叶斯网络荟萃分析，以合并每个结局的汇总直接和间接治疗效果估计值。
讨论
这是第一项旨在确定药物和营养治疗对缩短儿童AD/AGE病程的相对有效性的系统评价和网络荟萃分析。结果将有助于减少干预措施有效性的不确定性，发现知识空白，和/或鼓励对其他治疗选择进行进一步研究。
系统评价注册
PROSPERO注册号：CRD42015023778。
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