Intensive Care Unit, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China.
Medicine (Baltimore). 2021 Apr 9;100(14):e25408. doi: 10.1097/MD.0000000000025408.
Acute respiratory distress syndrome (ARDS) is caused by an inflammatory injury to the lung. Dysregulated inflammation is the cardinal feature of ARDS. Methylprednisolone is an option for treating ARDS. However, the benefits and adverse effects of methylprednisolone have not been well assessed in patients with ARDS. This study aimed to evaluate the efficacy and safety of methylprednisolone against ARDS.
The electronic database of Embase, PubMed, the Cochrane Library, CNKI, and Wanfang were searched, and randomized controlled trials (RCTs) reporting the efficacy and safety of methylprednisolone for ARDS were included. Revman 5.3 and Stata 15.0 were used to conduct the analysis. The fixed-effects model was used to calculate summary odds ratios (ORs) and 95% confidence interval (CIs).
Ten RCTs studies involving 692 patients with ARDS. The summary results demonstrated that, compared with placebo, methylprednisolone had a statistically significant effect on mortality (OR = 0.64; 95% CI: 0.43-0.95, I2 = 42%); the time of mechanical ventilation (MD) = -2.70, 95% CI: -3.31 to -2.10; I2 = 0%) in patients with ARDS, but it was not associated with increased rates of adverse events (OR = 0.80; 95% CI: 0.34-1.86; I2 = 58%).
This systematic review and meta-analysis demonstrated that Methylprednisolone is safe against ARDS. It may reduce mortality and shorten the time of mechanical ventilation. However, well-designed and large-sample studies were required to fully characterize the efficacy and safety of methylprednisolone against ARDS.
急性呼吸窘迫综合征（ARDS）是由肺部炎症损伤引起的。调节异常的炎症是 ARDS 的主要特征。甲泼尼龙是治疗 ARDS 的一种选择。然而，在 ARDS 患者中，尚未充分评估甲泼尼龙的疗效和不良反应。本研究旨在评估甲泼尼龙治疗 ARDS 的疗效和安全性。
检索 Embase、PubMed、Cochrane 图书馆、中国知网和万方数据库，纳入报告甲泼尼龙治疗 ARDS 的疗效和安全性的随机对照试验（RCT）。使用 Revman 5.3 和 Stata 15.0 进行分析。使用固定效应模型计算汇总优势比（OR）和 95%置信区间（CI）。
纳入 10 项 RCT 研究，共 692 例 ARDS 患者。汇总结果表明，与安慰剂相比，甲泼尼龙治疗 ARDS 患者的死亡率具有统计学意义（OR=0.64；95%CI：0.43-0.95，I2=42%）；机械通气时间（MD）=-2.70，95%CI：-3.31 至-2.10；I2=0%），但与不良反应发生率增加无关（OR=0.80；95%CI：0.34-1.86；I2=58%）。
本系统评价和荟萃分析表明，甲泼尼龙治疗 ARDS 是安全的。它可能降低死亡率并缩短机械通气时间。然而，需要设计良好、样本量大的研究来充分描述甲泼尼龙治疗 ARDS 的疗效和安全性。
