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目的系统评价血浆置换(PE)、静脉注射免疫球蛋白(IVIG)、激素对吉兰-巴雷综合征(GBS)的治疗效果。方法计算机检索Pub Med、Cochrane Library、中国知网、万方数据库、维普资讯中关于PE、IVIG、激素治疗GBS的随机对照试验(RCT),同时对纳入文献的参考文献,根据纳入和排除标准严格筛选,对符合纳入标准的研究采用Rev Man 5.2软件进行meta分析。结果共纳入14篇符合标准的RCT,均采用GBS 7分残疾量表评价残疾等级的改变。Meta分析结果显示:14个RCT共585例:PE组4周后残疾等级的改善明显高于对照组[WMD=-0.89;95%CI=-1.14~-0.63,假设检验z=6.89,P<0.01];25个RCT共536例:IVIG组与PE组4周后残疾等级的改善无明显区别[WMD=-0.02;95%CI=-0.25~0.20,假设检验z=0.21,P=0.83];35个RCT共547例:激素组与对照组4周后残疾等级的改善无明显区别[WMD=0.34;95%CI-0.28~0.96,假设检验z=1.06,P=0.29]。结论 PE可以加快GBS患者的神经功能恢复;IVIG、PE治疗GBS有类似的疗效;激素没有显著改善GBS患者的神经功能。
Objective To systematically evaluate the therapeutic effects of plasma exchange (PE), intravenous immunoglobulin (IVIG) and hormones on Guillain-Barre syndrome (GBS). Methods Randomized controlled trials (RCTs) of PE, IVIG and hormone therapy GBS were searched by Pub Med, Cochrane Library, China National Knowledge Infrastructure, Wanfang database and VIP information, and the references included in the literature were strictly controlled according to inclusion and exclusion criteria Screening, and met inclusion criteria for meta-analysis using Rev Man 5.2 software. Results A total of 14 eligible RCTs were included in the study, and the disability scale was assessed using GBS 7-point disability scale. Meta analysis showed that there were 585 cases in 14 RCTs: The improvement of disability grade in PE group after 4 weeks was significantly higher than that in control group [WMD = -0.89; 95% CI = -1.14 ~ -0.63, hypothesis test z = 6.89, P < 0.01]. There were 536 cases with 25 RCTs. There was no significant difference in the improvement of disability grade between IVIG group and PE group after 4 weeks [WMD = -0.02; 95% CI = -0.25-0.20, hypothesis test z = 0.21, P = 0.83] ; There were 547 RCTs in 54 RCTs. There was no significant difference in the improvement of disability grade between the hormone group and the control group after 4 weeks [WMD = 0.34; 95% CI -0.28 to 0.96, hypothesis test z = 1.06, P = 0.29]. Conclusions PE can accelerate the recovery of neurological function in patients with GBS. IVIG and PE have a similar therapeutic effect on GBS. Hormone does not significantly improve the neurological function in patients with GBS.