Yao Zhong, Hu Xin, Ma Lu, You Chao
Department of Neurosurgery, West China Hospital, Sichuan University and West China Brain Research Centre, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, China.
Acta Neurochir (Wien). 2017 Nov;159(11):2037-2044. doi: 10.1007/s00701-017-3309-7. Epub 2017 Sep 1.
Chronic subdural haematoma is a common but retractable neurological disease in the elderly with a high rate of recurrence. Dexamethasone (DX) either as monotherapy or adjuvant therapy has been applied clinically, but its effectiveness and feasibility remain controversial. We conducted this review to clarify this issue.
With a systematic review through multiple databases, we retrieved eligible English language publications and extracted relevant data to perform meta-analyses. The respective risk ratio (RR) and its 95% confidence interval (CI) were pooled to evaluate the overall effect.
Our meta-analysis showed overall that DX (alone or adjuvant) resulted in a lower recurrence rate when compared with non-DX therapy (RR, 0.54; 95% CI, 0.33-0.88; p = 0.01), but sensitivity analysis by excluding the most influential study achieved inconsistent results. The pooled effect revealed no statistical difference on recurrence rate between DX alone and non-DX therapy or surgical therapy (RR, 0.86; 95% CI, 0.43-1.71; p = 0.66) (RR, 0.89; 95% CI, 0.43-1.85; p = 0.76). Comparison between DX alone with the surgical therapy demonstrated no difference on the poor outcome (RR, 0.40; 95% CI, 0.15-1.04; p = 0.06).
We had no enough evidence to support DX use as an effective alternation to surgical therapy. But adjuvant DX use may facilitate the surgical therapy by reducing recurrence. Further study focusing on adjuvant DX was required.
慢性硬膜下血肿是老年人常见但可治愈的神经系统疾病，复发率高。地塞米松（DX）作为单一疗法或辅助疗法已在临床上应用，但其有效性和可行性仍存在争议。我们进行本综述以阐明这一问题。
通过多个数据库进行系统综述，检索符合条件的英文出版物并提取相关数据以进行荟萃分析。汇总各自的风险比（RR）及其95%置信区间（CI）以评估总体效果。
我们的荟萃分析总体显示，与非DX治疗相比，DX（单独或辅助）导致较低的复发率（RR，0.54；95%CI，0.33 - 0.88；p = 0.01），但通过排除最具影响力的研究进行敏感性分析得到了不一致的结果。汇总效应显示，单独使用DX与非DX治疗或手术治疗之间在复发率上无统计学差异（RR，0.86；95%CI，0.43 - 1.71；p = 0.66）（RR，0.89；95%CI，0.43 - 1.85；p = 0.76）。单独使用DX与手术治疗之间在不良结局方面无差异（RR，0.40；95%CI，0.15 - 1.04；p = 0.06）。
我们没有足够的证据支持将DX用作手术治疗的有效替代方法。但辅助使用DX可能通过降低复发率来促进手术治疗。需要进一步开展针对辅助使用DX的研究。
