目的 系統(tǒng)評價大劑量甲潑尼龍治療兒童難治性支原體肺炎（RMPP）的療效和安全性。方法 計(jì)算機(jī)檢索PubMed、EMbase、Cochrane Library、中國學(xué)術(shù)期刊全文數(shù)據(jù)庫（CNKI）、中國生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫（CBM）和維普中文期刊全文數(shù)據(jù)庫（VIP）和萬方數(shù)據(jù)庫，檢索年限均為數(shù)據(jù)庫建庫至2020年2月，搜集大劑量[>2 mg/（kg·d）]甲潑尼龍靜脈滴注對比常規(guī)劑量[1~2 mg/（kg·d）]治療中國兒童RMPP的臨床對照研究（RCTs），提取數(shù)據(jù)后采用RevMan 5.3軟件進(jìn)行系統(tǒng)評價。結(jié)果 共納入13個RCTs，1 017例患兒，涉及甲潑尼龍劑量≤10 mg/（kg·d）和>10 mg/（kg·d）。Meta-分析結(jié)果顯示：（1）大劑量組臨床有效率（RR=1.12，95% CI=1.07~1.16）顯著高于對照組（P<0.01），亞組分析顯示≤10 mg/（kg·d）劑量組臨床有效率（RR=1.03，95% CI=0.99~1.08）與常規(guī)劑量組比較無顯著差異（P=0.18）；>10 mg/（kg·d）組臨床有效率（RR=1.20，95% CI=1.12~1.28）顯著優(yōu)于常規(guī)劑量組（P<0.01）。（2）大劑量組退熱時間（MD=-1.82，95% CI=-2.06~-1.57）、咳嗽消失時間（MD=-1.57，95% CI=-1.91~1.23）、肺部啰音消失時間（MD=-1.58，95% CI=-1.86~-1.31）和肺部陰影消失時間（MD=-5.30，95% CI=-7.84~-2.76）均顯著小于常規(guī)劑量組（P<0.01）。（3）≤10 mg/（kg·d）劑量組的肺部陰影吸收率顯著優(yōu)于常規(guī)劑量組（RR=1.32，95% CI=1.05~1.65，P=0.02）。（4）大劑量組C反應(yīng)蛋白水平（MD=-5.08，95% CI=-5.95~-4.21）顯著小于常規(guī)劑量組（P<0.01）。（5）大劑量組不良反應(yīng)發(fā)生率與常規(guī)劑量組相當(dāng)（RR=1.30，95% CI=0.99~1.71，P=0.06）。亞組分析顯示≤10 mg/（kg·d）組的不良反應(yīng)發(fā)生率（RR=0.99，95% CI=0.70~1.41，P=0.97）與常規(guī)劑量組比較無顯著性差異；而>10 mg/（kg·d）組不良反應(yīng)發(fā)生率（RR=2.05，95% CI=1.30~3.25，P<0.01）顯著大于常規(guī)劑量組。結(jié)論 大劑量甲潑尼龍能顯著提高兒童RMPP的臨床療效，縮短臨床癥狀改善時間，降低炎性因子水平，其中≤10 mg/（kg·d）是較佳劑量，在此劑量下未增加不良反應(yīng)發(fā)生率。

Objective To ystematically evaluate the efficacy and safety of high-dose methylprednisolone in the treatment of refractory mycoplasma pneumoniae pneumonia (RMPP) in children. Methods The databases PubMed, EMbase, The Cochrane Library, CNKI, CBM, VIP and Wanfang Data were searched for controlled trials (RCTs) of high-dose methylprednisolone[> 2 mg/(kg·d)] vs regular dose[1-2 mg/(kg·d) in the treatment of RMPP in children from Database building to February of 2020. After data extraction, Meta-analysis was performed by RevMan5.3 software. Results A total of 13 RCTs involving 1 107 patients were included. The results of Meta-analysis showed that:(1) The clinical effective rate in high-does group was significantly greater than that in the control group (RR=1.12, 95% CI=1.07 to 1.16, P<0.01). Subgroup analysis showed that the clinical effective rate of[ ≤ 10 mg/(kg·d)] group (RR=1.03, 95% CI=0.99 to 1.08) had no significant difference compared with the regular dose group (P=0.18), and[>10 mg/(kg·d)] group (RR=1.20, 95% CI=1.12 to 1.28) was significantly greater compared with the regular dose group (P<0.01); (2) High-dose group in fade time (MD=-1.82, 95% CI=-2.06 to-1.57), cough disappearing time (MD=-1.57, 95% CI=-1.91 to-1.23), pulmonary rales disappearing time (MD=-1.58, 95% CI=-1.86 to-1.31) and pulmonary shadow disappearing time (MD=-5.30, 95% CI=-7.84 to -2.76) were significantly shorten than the regular-dose group (P<0.01). (3) The lung shadow absorption rate of the high-dose group[ ≤ 10 mg/(kg·d)] had significantly higher than the regular-dose group (RR=1.32, 95% CI=1.05 to 1.65, P=0.02). (4) The CRP level in high-does group (MD=-5.08, 95% CI=-5.95 to-4.21) were significantly lower than that in the regular-dose group (P<0.01). (5) Rate of ADR in the high-dose group was similar to that in the regular-dose group (RR=1.30, 95% CI=0.99 to 1.71, P=0.06), subgroup analysis showed the rate of ADR of[ ≤ 10 mg/(kg·d)] group (RR=0.99, 95% CI=0.70 to 1.41, P=0.97) had no difference with regular-dose group, but[> 10 mg/(kg·d)] group (RR=2.05, 95% CI=1.30 to 3.25, P<0.01) was significantly higher than the regular-dose group. Conclusion High-dose methylprednisolone can significantly improve the clinical efficacy of RMPP in children, shorten the time to improve clinical symptoms, reduce the level of inflammatory factors, and not increase the incidence of adverse reactions, of which[ ≤ 10 mg/(kg·d)] is the optimal dose.

R969.3;R985

黃石市醫(yī)藥衛(wèi)生科研項(xiàng)目（2016-11）