ISSN 1674-3865  CN 21-1569/R
主管：国家卫生健康委员会
主办：中国医师协会
　　　辽宁省基础医学研究所
　　　辽宁中医药大学附属医院
中国中西医结合儿科学

中国中西医结合儿科学 ›› 2022, Vol. 14 ›› Issue (4): 300-307.

• 临床研究 • 上一篇    下一篇

早期应用促红细胞生成素对早产儿神经系统保护的有效性和安全性的Meta分析

  

  • 出版日期:2022-08-25 上线日期:2023-11-29

Efficacy and safety of early use of erythropoietin for neuroprotection in premature infants: a Meta-analysis

  • Published:2022-08-25 Online:2023-11-29

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摘要： 目的 系统评价早期应用促红细胞生成素(EPO)对早产儿神经系统保护的有效性和安全性。方法 计算机检索PubMed、Embase、The Cochrane Library、中国生物医学文献数据库(CBM)、中国知网(CNKI)、万方数据库(WanFang Data)和维普中文期刊全文数据库(VIP)等，收集有关EPO对早产儿神经系统保护的随机对照试验(RCTs),检索时限为建库到2020年12月31日，采用RevMan 5.3软件进行Meta分析。结果 共纳入16项RCTs,包括3 650例早产儿。Meta分析结果显示，小剂量EPO可提高早产儿校正年龄12～24个月时智力发育指数(MDI)[MD=7.26,95%CI(2.99,11.53),P=0.000 9]和运动发育指数(PDI)[MD=4.88,95%CI(1.76,7.99),P=0.002],并且可降低MDI<70的发生率[MD=0.41,95%CI(0.27,0.64),P<0.000 1],但大剂量EPO(≥1 000 U/kg)治疗组与对照组相比，差异无统计学意义(P>0.05);EPO治疗组相比于对照组，脑性瘫痪、听力损害、视力损害以及其他神经发育障碍的发生率均无统计学意义(P>0.05);EPO治疗可降低新生儿坏死性小肠结肠炎、脑室内出血(Ⅲ/Ⅳ度)和脑室周围白质软化的发生率，并且不会增加支气管肺发育不良和早产儿视网膜病(≥Ⅲ期)的发生风险。结论 早期应用小剂量EPO对早产儿神经系统有一定的保护作用且安全，大剂量EPO的神经保护作用需进一步探讨。受纳入研究数量和质量的限制，上述结论尚需更多高质量研究予以验证。

关键词:

神经发育, 早产, 促红细胞生成素, 随机对照试验, Meta分析

Abstract:

ObjectiveTo systematically evaluate the efficacy and safety of early use of erythropoietin(EPO) for neuroprotectionin premature infants.MethodsPubMed, Embase, The Cochrane Library, CBM, CNKI, WanFang Data and VIP databases were searched through computers to collect randomized controlled trials(RCTs) on EPO for neuroprotection in premature infants, the searching time being from inception to December,2020.RevMan 5.3 software was used for Meta-analysis.ResultsA total of 16 RCTs involving 3 650 premature infants were included. The results of meta-analysis showed that low-dose EPO could increase the mental development index(MDI)［MD=7.26，95%CI(2.99，11.53)，P=0.000 9］ and the psychomotor development index(PDI)［MD=4.88，95%CI(1.76，7.99)，P=0.002］ in the infants at adjusted age of 12 to 24 months， and it could reduce the incidence of MDI<70［MD=0.41,95%CI(0.27, 0.64),P<0.000 1］, but the effect of high-dose EPO（≥1 000 U/kg） treatment showed no difference between treatment group and control group(P>0.05). Compared with the control group, the incidence of cerebral palsy, hearing impairment, visual impairment and other neurodevelopmental disorders in the EPO group were not statistically different(P>0.05). EPO could reduce the incidence of necrotizing enterocolitis, intraventricular hemorrhage（Ⅲ/Ⅳ） and periventricular leukomalacia, without increasing the risk of bronchopulmonary dysplasia and retinopathy in prematurity（≥Ⅲ）.ConclusionLow-dose EPO treatment at an early stage can improve the neurodevelopmental outcomes of premature infants and is safe, but the effect of high-dose EPO needs further study.Due to limited quality and quantity of the included studies, more high quality studies are required to verify the above conclusions.

Key words:

Neurodevelopment, Premature, Erythropoietin, Randomized controlled trial, Meta-analysis