Liu Hanmin, Lu Quan, Hong Jianguo, Liu Enmei
Department of Pulmonology, West China the Second Hospital, Sichuan University, Chengdu 610041, China.
Zhonghua Er Ke Za Zhi. 2016 Feb;54(2):111-8. doi: 10.3760/cma.j.issn.0578-1310.2016.02.009.
To evaluate the therapeutic effects of antibacterial agents, glucocorticoid and intravenous immunoglobulin (IVIG) in treating Mycoplasma pneumoniae(MP) infections.
The literature was screened by the inclusion and exclusion criteria after searching at Cochrane Library, Pubmed, Wanfang, CNKI, and Weipu databases. According to JADAD evaluation system, the relevant information in each included report from the literature was evaluated. The evidence-based analysis was performed for the therapeutic effects of macrolides, glucocorticoid, and IVIG in treating MP infections. Meta-analysis was conducted on the suitable literature by RevMan 5.3 software supplied by Cochrane collaboration. Descriptive analysis was conducted on the literature unsuitable for meta-analysis.
(1) Seven foreign RCT reports and 7 domestic RCT reports were included in the analysis of the therapeutic effect of macrolides. There was a high heterogeneity among the 7 foreign reports. Five of these reports showed no significant difference in clinical effects between macrolides and non-macrolide antibacterial agents. The forest plot analysis of antipyretic timing and cough duration in the domestic literature with complete indicators suggested that for azithromycin sequential therapy vs. erythromycin intravenous therapy, the mean difference of antipyretic timing was-1.10 (95% CI: -1.60,-0.60) and the mean difference of cough duration was-1.56 (95% CI: -2.10,-1.03). (2) Three foreign RCT reports and 5 domestic RCT were included in the analysis of glucocorticoid therapy. The JADAD scores of all the reports were 1. The basic therapy drug was macrolides. The results of sub-group analysis suggested that for the patients who used glucocorticoid early vs. the patients who used non-glucocorticoid therapy, the mean difference of antipyretic time was-1.77(95% CI: -2.44,-1.10) and the mean difference of cough duration was-2.47 (95% CI: -2.86,-2.08); for the patients treated with glucocorticoid at 10 days after onset of diseases vs. the patients received non-glucocorticoid therapy, the mean difference of antipyretic time was-3.41 (95% CI: -4.10,-2.73) and the mean difference of cough duration was-2.25 (95%CI: -4.38,-0.12). (3) Regarding IVIG, all the included reports were case study or case report. Most of the literature focused on severe Mycoplasma pneumoniae infection and those with extrapulmonary complications. The limited results suggested a trend of the shortening of disease process and improvement of clinical symptoms by IVIG.
There was no exact evidence of the therapeutic effects of antibacterial agents in Mycoplasma pneumoniae infections. A trend of better therapeutic effect was inferred in macrolide antibiotics, especially azithromycin. The improvement of clinical symptoms was suggested with the usage of glucocorticoid as adjuvant therapy. IVIG as an adjuvant therapy is at an exploration stage.
评估抗菌药物、糖皮质激素及静脉注射免疫球蛋白（IVIG）治疗肺炎支原体（MP）感染的疗效。
通过检索Cochrane图书馆、Pubmed、万方、知网及维普数据库，依据纳入与排除标准筛选文献。根据JADAD评估系统，对文献中各纳入报告的相关信息进行评估。对大环内酯类、糖皮质激素及IVIG治疗MP感染的疗效进行循证分析。运用Cochrane协作网提供的RevMan 5.3软件对合适的文献进行Meta分析。对不适合进行Meta分析的文献进行描述性分析。
（1）大环内酯类疗效分析纳入7篇国外随机对照试验（RCT）报告和7篇国内RCT报告。7篇国外报告间异质性较高。其中5篇报告显示大环内酯类与非大环内酯类抗菌药物临床疗效无显著差异。国内指标完整文献中关于退热时间及咳嗽持续时间的森林图分析显示，阿奇霉素序贯疗法与红霉素静脉疗法相比，退热时间的平均差值为-1.10（95%可信区间：-1.60，-0.60），咳嗽持续时间的平均差值为-1.56（95%可信区间：-2.10，-1.03）。（2）糖皮质激素治疗分析纳入3篇国外RCT报告和5篇国内RCT报告。所有报告的JADAD评分为1分。基础治疗药物为大环内酯类。亚组分析结果显示，早期使用糖皮质激素患者与未使用糖皮质激素治疗患者相比，退热时间的平均差值为-1.77（95%可信区间：-2.44，-1.10），咳嗽持续时间的平均差值为-2.47（95%可信区间：-2.86，-2.08）；发病1十天后使用糖皮质激素治疗患者与未接受糖皮质激素治疗患者相比，退热时间的平均差值为-3.41（95%可信区间：-4.10，-2.73），咳嗽持续时间的平均差值为-2.25（95%可信区间：-4.38，-0.12）。（3）关于IVIG，所有纳入报告均为病例研究或病例报告。多数文献聚焦于重症肺炎支原体感染及合并肺外并发症者。有限结果提示IVIG有缩短病程、改善临床症状的趋势。
抗菌药物治疗肺炎支原体感染尚无确切疗效证据。大环内酯类抗生素尤其是阿奇霉素有疗效更佳的趋势。糖皮质激素作为辅助治疗可改善临床症状。IVIG作为辅助治疗尚处于探索阶段。
