Leitich H, Egarter C, Reisenberger K, Kaider A, Berghammer P
Department of Obstetrics and Gynecology, University of Vienna, Austria.
Am J Obstet Gynecol. 1998 May;178(5):899-908. doi: 10.1016/s0002-9378(98)70521-6.
This study was performed to investigate whether the demonstrated beneficial effects of antibiotics on maternal and neonatal morbidity are altered when glucocorticoids are part of the treatment of preterm premature rupture of membranes.
We performed a metaanalysis of five published, randomized trials of antibiotic treatment in preterm premature rupture of membranes in which glucocorticoids were used as additional treatments and compared the results with those of a previously published metaanalysis of antibiotic treatment in preterm premature rupture of membranes, which excluded studies with concomitant glucocorticoids. Primary outcomes included chorioamnionitis, postpartum endometritis, neonatal sepsis, respiratory distress syndrome, intraventricular hemorrhage, necrotizing enterocolitis, and neonatal mortality. A logistic regression analysis was performed to test whether glucocorticoids significantly influenced the effect of antibiotic treatment.
Among the 509 patients from five trials on antibiotic and glucocorticoid treatment published between 1986 and 1993 antibiotic therapy did not show any significant effect on any of the outcomes analyzed. In contrast, antibiotic therapy without concomitant use of glucocorticoids significantly reduced the odds of chorioamnionitis, postpartum endometritis, neonatal sepsis, and intraventricular hemorrhage by 62%, 50%, 68%, and 50%, respectively. The logistic regression analysis showed that glucocorticoids significantly diminished the effect of antibiotic treatment on chorioamnionitis and neonatal sepsis.
Glucocorticoids appear to diminish the beneficial effects of antibiotics in the treatment of preterm premature rupture of membranes. A careful selection of patients who are likely to benefit from both therapies is therefore recommended.
本研究旨在调查当糖皮质激素作为胎膜早破早产治疗的一部分时，抗生素对孕产妇和新生儿发病率已证实的有益作用是否会改变。
我们对五项已发表的关于胎膜早破早产抗生素治疗的随机试验进行了荟萃分析，这些试验中糖皮质激素被用作辅助治疗，并将结果与之前发表的一项关于胎膜早破早产抗生素治疗的荟萃分析结果进行比较，后者排除了同时使用糖皮质激素的研究。主要结局包括绒毛膜羊膜炎、产后子宫内膜炎、新生儿败血症、呼吸窘迫综合征、脑室内出血、坏死性小肠结肠炎和新生儿死亡率。进行逻辑回归分析以检验糖皮质激素是否显著影响抗生素治疗的效果。
在1986年至1993年间发表的五项关于抗生素和糖皮质激素治疗的试验中的509例患者中，抗生素治疗对所分析的任何结局均未显示出显著效果。相比之下，未同时使用糖皮质激素的抗生素治疗分别使绒毛膜羊膜炎、产后子宫内膜炎、新生儿败血症和脑室内出血的几率显著降低了62%、50%、68%和50%。逻辑回归分析表明，糖皮质激素显著削弱了抗生素治疗对绒毛膜羊膜炎和新生儿败血症的效果。
糖皮质激素似乎会削弱抗生素在治疗胎膜早破早产中的有益作用。因此，建议谨慎选择可能从两种治疗中均获益的患者。
