氨基糖苷类药物的使用与重症监护病房获得性肌无力：系统评价和荟萃分析。
Aminoglycoside use and intensive care unit-acquired weakness: A systematic review and meta-analysis.
机构信息
Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Department of Critical Care Medicine, North China University of Science and Technology Affiliated Hospital, Tangshan, China.
出版信息
PLoS One. 2020 Mar 19;15(3):e0230181. doi: 10.1371/journal.pone.0230181. eCollection 2020.
BACKGROUND
The relationship between aminoglycoside use and intensive care unit (ICU)-acquired weakness remains controversial. In the present study, we performed a systematic review and meta-analysis to examine the relationship between aminoglycoside use and ICU-acquired weakness in critically ill patients.
METHODS
The PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials and Cumulative Index of Nursing and Allied Health Literature databases were searched from the earliest available date to July 10, 2019. Randomized controlled trials and prospective cohort studies examining the relationship between aminoglycosides and ICU-acquired weakness in adult ICU patients were included. Two authors independently screened titles/abstracts, reviewed full text and extracted data from the included studies. We performed the Meta-analysis using Stata version 15.0 and used the DerSimonian-Laird random effects model for data analyses. Heterogeneity was evaluated using the χ2 statistic and I2 statistic. Publication bias was evaluated with funnel plots qualitatively, the Begg's test and Egger's test quantitatively.
RESULTS
Ten prospective cohort studies were included and analysed in this review. The overall effect sizes of the studies revealed a statistically significant relationship between aminoglycoside use and ICU-acquired weakness (OR, 2.06; 95%CI, 1.33-3.21; I2 = 56%). Subgroup and sensitivity analyses suggested a significant association between aminoglycoside use and studies limited to patients with clinical weakness (OR, 2.74; 95%CI, 1.83-4.10; I2 = 0%), and not to studies limited to patients with abnormal electrophysiology (OR, 1.78; 95%CI, 0.94-3.39; I2 = 59%), a large sample size (OR, 1.81; 95%CI, 0.97-3.39; I2 = 75%), or low risk of bias (OR, 1.59; 95%CI, 0.97-2.60; I2 = 56%); however, statistical heterogeneity was obvious. There were no significant publication biases found in the review.
CONCLUSIONS
The review revealed a significant relationship between aminoglycoside use and ICU-acquired weakness.
背景
氨基糖苷类药物的使用与重症监护病房（ICU）获得性肌无力之间的关系仍存在争议。本研究通过系统评价和荟萃分析，旨在探讨危重病患者中氨基糖苷类药物的使用与 ICU 获得性肌无力之间的关系。
方法
检索 PubMed、Embase、Web of Science、Cochrane 中心对照试验注册库和 Cumulative Index of Nursing and Allied Health Literature 数据库，检索时间为最早可获得日期至 2019 年 7 月 10 日。纳入评估成人 ICU 患者中氨基糖苷类药物与 ICU 获得性肌无力之间关系的随机对照试验和前瞻性队列研究。两位作者独立筛选标题/摘要、审查全文并从纳入研究中提取数据。使用 Stata 版本 15.0 进行 Meta 分析，并使用 DerSimonian-Laird 随机效应模型进行数据分析。使用 χ2 统计量和 I2 统计量评估异质性。使用漏斗图定性评估发表偏倚，Begg 检验和 Egger 检验定量评估发表偏倚。
结果
纳入本综述的研究共有 10 项前瞻性队列研究。研究的总效应大小表明，氨基糖苷类药物的使用与 ICU 获得性肌无力之间存在统计学显著关系（OR，2.06；95%CI，1.33-3.21；I2 = 56%）。亚组和敏感性分析表明，氨基糖苷类药物的使用与仅限于有临床肌无力的患者的研究之间存在显著关联（OR，2.74；95%CI，1.83-4.10；I2 = 0%），而与仅限于有异常电生理学的患者的研究无显著关联（OR，1.78；95%CI，0.94-3.39；I2 = 59%），大样本量（OR，1.81；95%CI，0.97-3.39；I2 = 75%）或低偏倚风险（OR，1.59；95%CI，0.97-2.60；I2 = 56%）的研究无显著关联；然而，异质性明显。本综述未发现明显的发表偏倚。
结论
本综述结果表明，氨基糖苷类药物的使用与 ICU 获得性肌无力之间存在显著关系。
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