Zhang Haoyang, Liu Jing, Liu Tianhao, Wang Yu, Dai Weidan
Liaoning University of Traditional Chinese Medicine, Shenyang, China.
Yunnan University of Traditional Chinese Medicine, Kunming, China.
Clin Respir J. 2018 Oct;12(10):2480-2490. doi: 10.1111/crj.12923. Epub 2018 Sep 27.
High incidence of respiratory distress syndrome (RDS) was revealed in preterm infants, which acted as one of the main factors that led to infant death.
This network meta-analysis (NMA) was performed to rank the efficacy of different therapies in preventing for premature infants.
PubMed, Embase, Cochrane Library, CINAHL, and CNKI were searched. Statistical analysis was performed using STATA statistical software (Version 12.0). Odds ratios (ORs) with 95% credible intervals (95%CrIs) were applied to evaluate relative efficacy of various treatments. Ranking of probabilities of each treatment was illustrated by surface under the cumulative ranking curve (SUCRA). Consistency between direct and indirect evidence was assessed using the node-splitting plots and heat plots.
A total of 48 trials were eligible to evaluate the efficacy of 3 interventions including ambroxol (AMB), betamethasone (BET), and dexamethasone (DEX). Three outcomes including the incidence of RDS, bronchopulmonary dysplasia (BPD) and neonatal death were assessed. Compared with placebo, BET, DEX, and AMB all demonstrated better efficacy in terms of preventing RDS and neonatal death. No significant difference among treatments was found in the assessment of the incidence of BPD. According to SUCRA, AMB was the optimal treatment in preventing RDS and neonatal death. Besides, no significant inconsistency was detected between direct and indirect evidence. To conclude, no significant difference was found among these three medications. AMB seems to have the potential to be the most effective treatment for reducing the incidence of RDS and neonatal death.
早产儿呼吸窘迫综合征（RDS）发病率较高，这是导致婴儿死亡的主要因素之一。
进行此项网络荟萃分析（NMA）以对不同疗法预防早产儿的疗效进行排序。
检索了PubMed、Embase、Cochrane图书馆、CINAHL和中国知网。使用STATA统计软件（版本12.0）进行统计分析。应用比值比（OR）及95%可信区间（95%CrI）评估各种治疗的相对疗效。通过累积排序曲线下面积（SUCRA）说明每种治疗的概率排名。使用节点拆分图和热图评估直接证据与间接证据之间的一致性。
共有48项试验符合条件，以评估氨溴索（AMB）、倍他米松（BET）和地塞米松（DEX）这3种干预措施的疗效。评估了包括RDS发病率、支气管肺发育不良（BPD）和新生儿死亡在内的3项结局。与安慰剂相比，BET、DEX和AMB在预防RDS和新生儿死亡方面均显示出更好的疗效。在BPD发病率评估中，各治疗组间未发现显著差异。根据SUCRA，AMB是预防RDS和新生儿死亡的最佳治疗方法。此外，直接证据与间接证据之间未检测到显著不一致。总之，这三种药物之间未发现显著差异。AMB似乎有可能成为降低RDS发病率和新生儿死亡的最有效治疗方法。
