Department of Internal Medicine, Department of Internal Medicine, Mount Sinai Hospital, Chicago, Illinois, USA.
Department of Internal Medicine, Department of Internal Medicine, Bronxcare Health System, Bronx, New York, USA.
World Neurosurg. 2022 Feb;158:84-99. doi: 10.1016/j.wneu.2021.10.167. Epub 2021 Oct 30.
Chronic subdural hematoma (CSDH) is a neurologic condition characterized as a hematoma in the subdural space with a period >3 weeks that primarily affects the elderly. Glucocorticoid, especially dexamethasone, either alone or combined with surgery, has been used to manage CSDH. We aimed to perform an updated systematic review and meta-analysis of the literature regarding the role of steroids in CSDH.
We searched the electronic databases PubMed, PubMed Central, Scopus, and Embase for relevant articles until December 2020. Study characteristics, quality, and end points were extracted, and analysis was performed by RevMan 5.4.
The odds for subdural hematoma recurrence were decreased by 61% in the steroid group (odds ratio [OR], 0.39; confidence interval [CI], 0.19-0.79) compared with the control group. There was no significant difference in mortality during the study period (OR, 0.66; CI, 0.20-2.18), modified Rankin Scale score 0-3 (OR, 0.87; CI, 0.31-2.40), and modified Rankin Scale score 4-6 (OR, 1.15; CI, 0.42-3.18) between the 2 groups. However, pooling data from 3 studies showed 2.7 times higher odds of occurring adverse effects in steroid groups using the fixed-effect model (OR, 2.70; CI, 1.71-4.28). The treatment success was similar between the steroid and control groups (OR, 2.39; CI, 0.94-6.04).
Treatment with steroids was associated with a lesser recurrence of CSDH. However, there was no benefit of steroid treatment in CSDH compared with nonsteroid treatment in terms of mortality and treatment success and some but significantly increased risk of adverse events.
慢性硬脑膜下血肿（CSDH）是一种神经学疾病，表现为硬脑膜下腔血肿，持续时间＞3 周，主要影响老年人。糖皮质激素，特别是地塞米松，单独使用或与手术联合使用，已被用于治疗 CSDH。我们旨在对有关类固醇在 CSDH 中作用的文献进行更新的系统评价和荟萃分析。
我们在电子数据库 PubMed、PubMed Central、Scopus 和 Embase 中搜索相关文章，直到 2020 年 12 月。提取研究特征、质量和终点，并使用 RevMan 5.4 进行分析。
与对照组相比，类固醇组硬膜下血肿复发的几率降低了 61%（比值比 [OR]，0.39；置信区间 [CI]，0.19-0.79）。在研究期间，两组之间的死亡率无显著差异（OR，0.66；CI，0.20-2.18）、改良 Rankin 量表评分 0-3 分（OR，0.87；CI，0.31-2.40）和改良 Rankin 量表评分 4-6 分（OR，1.15；CI，0.42-3.18）。然而，使用固定效应模型对 3 项研究的数据进行汇总显示，类固醇组发生不良反应的几率高出 2.7 倍（OR，2.70；CI，1.71-4.28）。类固醇组和对照组的治疗成功率相似（OR，2.39；CI，0.94-6.04）。
类固醇治疗与 CSDH 复发率降低有关。然而，与非类固醇治疗相比，类固醇治疗在 CSDH 患者的死亡率和治疗成功率方面没有获益，而且还存在一些但显著增加的不良反应风险。
