Liu Xinliang, Sun Dehong, Ma Xiaosong, Li Chuansheng, Ying Jie, Yan Youde
Department of Endocrinology, People's Hospital of Xuyi, Xuyi, Jiangsu, PR China.
Department of Gastroenterology, People's Hospital of Xuyi, Xuyi, Jiangsu, PR China.
Steroids. 2017 Dec;128:89-94. doi: 10.1016/j.steroids.2017.09.002. Epub 2017 Sep 9.
The efficacy, safety and health-economic outcomes were compared between corticosteroid and non-corticosteroid treatments in acute gout patients. All electronic literatures comparing the curative effects or full economic evaluations of corticosteroids versus non-corticosteroids on acute pain in acute gout patients and published until June 30, 2017 in any language were searched through PubMed, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials. Pooled odds ratios with 95% confidence intervals and standard(or weighted) mean difference were calculated using random-or fixed-effects models according to the I statistic test of heterogeneity. Economic elevations were combined through qualitative narrative synthesis. Finally, seven randomized controlled trials(RCTs) involving 929 patients were included here and suggested corticosteroids had comparable analgesic efficacy to non-corticosteroids on day 5. As for inflammation and PGA, corticosteroids might outperform non-corticosteroids in reducing tenderness and swelling. Corticosteroids versus non-corticosteroids could significantly reduce incidence of only serious adverse advents, but not total adverse advents, with substantial heterogeneity. Qualitative narrative synthesis of economic elevation involving only one study shows corticosteroids are more cost-effective than indomethacin. The existing RCTs do not provide sufficient or precise evidence that corticosteroids are superior to non-corticosteroids in pain relief of acute gout patients. Therefore, studies on chronic use of corticosteroids or comparative studies with colchicine, tramadol and/or opiates may be needed in the future, as is patient satisfaction with analgesic control.
在急性痛风患者中，比较了皮质类固醇与非皮质类固醇治疗的疗效、安全性和健康经济结果。通过PubMed、EMBASE、科学网和Cochrane对照试验中央注册库检索了截至2017年6月30日以任何语言发表的所有比较皮质类固醇与非皮质类固醇对急性痛风患者急性疼痛的疗效或全面经济评估的电子文献。根据异质性的I统计检验，使用随机或固定效应模型计算合并比值比及95%置信区间和标准（或加权）平均差。通过定性叙述性综合对经济评价进行合并。最终，纳入了7项涉及929例患者的随机对照试验（RCT），结果表明在第5天时皮质类固醇与非皮质类固醇的镇痛效果相当。至于炎症和患者总体评估（PGA），皮质类固醇在减轻压痛和肿胀方面可能优于非皮质类固醇。皮质类固醇与非皮质类固醇相比，仅能显著降低严重不良事件的发生率，而不能降低总不良事件的发生率，且存在较大异质性。仅涉及一项研究的经济评价定性叙述性综合表明，皮质类固醇比吲哚美辛更具成本效益。现有的随机对照试验没有提供充分或精确的证据表明皮质类固醇在缓解急性痛风患者疼痛方面优于非皮质类固醇。因此，未来可能需要开展关于皮质类固醇长期使用的研究，或与秋水仙碱、曲马多和/或阿片类药物的比较研究，以及患者对镇痛控制的满意度研究。
