Shao Mei, Xu Peng, Liu Jun, Liu Wenyun, Wu Xiujie
Department of Neurosurgery, Linyi People's Hospital.
Department of Neurosurgery, Linyi Yishui Central Hospital, Linyi.
Patient Prefer Adherence. 2016 Jul 14;10:1243-9. doi: 10.2147/PPA.S109720. eCollection 2016.
Bacterial meningitis is a serious infection in children and adults worldwide, with considerable morbidity, mortality, and severe neurological sequelae. Dexamethasone is often used before antibiotics in cases of this disease, and improves outcomes.
Although several studies have identified the role of adjunctive dexamethasone therapy in the treatment of bacterial meningitis, the results are still inconclusive. The aim of this study was to systematically evaluate the therapeutic and adverse effect of adjunctive dexa-methasone in patients with bacterial meningitis.
Relevant randomized, double-blind, placebo-controlled trials of dexamethasone in bacterial meningitis published between 2000 and 2016 were retrieved from the common electronic databases. The odds ratio (OR) and risk ratio (RR) with their 95% confidence interval (CI) were employed to calculate the effect.
A total of ten articles including 2,459 bacterial meningitis patients (1,245 in the dex-amethasone group and 1,214 in the placebo group) were included in this meta-analysis. Our result found that dexamethasone was not associated with a significant reduction in follow-up mortality (292 of 1,245 on dexamethasone versus 314 of 1,214 on placebo; OR =0.91, 95% CI =0.80-1.03, P=0.14) and severe neurological sequelae (22.4% versus 24.1%, OR =0.84, 95% CI =0.54-1.29, P=0.42). However, dexamethasone seemed to reduce hearing loss among survivors (21.2% versus 26.1%; OR =0.76, 95% CI =0.59-0.98, P=0.03). No significant difference was found between these two groups in adverse events.
Our results suggested that adjunctive dexamethasone might not be beneficial in the treatment of bacterial meningitis. Future studies with more data are needed to further prove the role of dexamethasone in bacterial meningitis.
细菌性脑膜炎是全球儿童和成人中的一种严重感染性疾病，具有较高的发病率、死亡率和严重的神经后遗症。地塞米松常用于该病患者在使用抗生素之前，可改善治疗结果。
尽管多项研究已确定辅助使用地塞米松治疗细菌性脑膜炎的作用，但结果仍不明确。本研究的目的是系统评价辅助使用地塞米松治疗细菌性脑膜炎患者的疗效和不良反应。
从常见电子数据库中检索2000年至2016年发表的关于地塞米松治疗细菌性脑膜炎的相关随机、双盲、安慰剂对照试验。采用比值比（OR）和风险比（RR）及其95%置信区间（CI）计算效应量。
本荟萃分析共纳入10篇文章，涉及2459例细菌性脑膜炎患者（地塞米松组1245例，安慰剂组1214例）。我们的结果发现，地塞米松与随访死亡率的显著降低无关（地塞米松组1245例中有292例死亡，安慰剂组1214例中有314例死亡；OR =0.91，95%CI =0.80 - 1.03，P =0.14），与严重神经后遗症的显著降低也无关（分别为22.4%和24.1%，OR =0.84，95%CI =0.54 - 1.29，P =0.42）。然而，地塞米松似乎可降低幸存者的听力损失发生率（分别为21.2%和26.1%；OR =0.76，95%CI =0.59 - 0.98，P =0.03）。两组在不良事件方面未发现显著差异。
我们的结果表明，辅助使用地塞米松治疗细菌性脑膜炎可能并无益处。需要更多数据的未来研究来进一步证实其在细菌性脑膜炎中的作用。
