Wang E E, Ohlsson A, Kellner J D
Division of Infectious Disease, Hospital for Sick Children, Toronto, Ontario, Canada.
J Pediatr. 1995 Oct;127(4):640-4. doi: 10.1016/s0022-3476(95)70130-3.
We performed a metaanalysis to determine whether there is an association between Ureaplasma urealyticum and chronic lung disease of prematurity (CLD); most studies involved small sample sizes, and the reported lack of statistical significance could have been due to inadequate power.
Articles were identified from the literature through a search of MEDLINE, Excerpta Medica, and Reference Update, with the search terms "Ureaplasma urealyticum," "CLD," and "bronchopulmonary dysplasia." The search was initially conducted in June 1994 and updated in March 1995. Abstracts were identified through a hand search of proceedings from two meetings for the years 1987 through 1994. Summary data on frequency of CLD in U. urealyticum-colonized and uncolonized babies were independently determined by the three authors. Preterm and term neonates were included. Colonization required recovery of U. urealyticum from a respiratory or surface specimen. The presence of CLD at 28 or 30 days was determined.
Seventeen publications comprising 13 full publications and 4 abstracts were included in the analysis. The estimates for relative risk (RR) exceeded one in all studies, although the lower confidence interval included one in seven studies. The RR for the development of CLD in colonized neonates was 1.72 (95% confidence interval, 1.5 to 1.96) times that for uncolonized neonates. The RR was not significantly different for abstracts versus full publications; studies focusing on extremely premature, low birth weight neonates versus studies including all neonates; and studies in which only endotracheal aspirates were used to define colonization versus others. The RR since surfactant use was somewhat lower than in studies in which receipt of surfactant was unknown.
This metaanalysis supports a significant association between U. urealyticum colonization and subsequent development of CLD. A randomized, controlled trial showing a reduction in CLD through the use of an antibiotic effective against U. urealyticum would provide further support of a causative role for this agent.
我们进行了一项荟萃分析，以确定解脲脲原体与早产儿慢性肺病（CLD）之间是否存在关联；大多数研究样本量较小，报告中缺乏统计学意义可能是由于检验效能不足。
通过检索MEDLINE、医学文摘数据库（Excerpta Medica）和《参考文献更新》（Reference Update）从文献中确定文章，检索词为“解脲脲原体”“CLD”和“支气管肺发育不良”。检索最初于1994年6月进行，并于1995年3月更新。通过手工检索1987年至1994年两次会议的会议记录来确定摘要。三位作者独立确定解脲脲原体定植和未定植婴儿中CLD发生频率的汇总数据。纳入早产儿和足月儿。定植要求从呼吸道或体表标本中分离出解脲脲原体。确定在28天或30天时是否存在CLD。
分析纳入了17篇出版物，包括13篇全文出版物和4篇摘要。所有研究中相对风险（RR）估计值均超过1，尽管7项研究的置信区间下限包含1。定植新生儿发生CLD的RR是未定植新生儿的1.72倍（95%置信区间，1.5至1.96）。摘要与全文出版物、关注极早产儿和低出生体重儿的研究与纳入所有新生儿的研究、仅使用气管内吸出物定义定植的研究与其他研究之间的RR无显著差异。自使用表面活性剂以来的RR略低于接受表面活性剂情况未知的研究。
这项荟萃分析支持解脲脲原体定植与随后发生CLD之间存在显著关联。一项随机对照试验若显示通过使用对解脲脲原体有效的抗生素可降低CLD发生率，将进一步支持该病原体的致病作用。
