|
|
|
|
| 应用皮质激素预防带状疱疹后神经痛 |
|
|
|
|
|
| Corticosteroids for preventing postherpetic neuralgia |
|
|
|
|
|
| He L., Zhang D., Zhou M., Zhu C. 2009/5/29 18:39:20 |
|
|
【发表评论】
|
|
|
|
|
打印|
推荐给好友
|
|
|
Cochrane Database of Systematic Reviews, 2008, Volume 0, Issue 1
|
|
|
|
|
|
|
| Background: Postherpetic neuralgia is a common serious complication of herpes zoster. Corticosteroids are anti-inflammatory andmight be beneficial. Objectives: To examine the efficacy of corticosteroids in preventing postherpetic neuralgia. Search strategy: Search for randomised or quasi-randomised controlled trials for corticosteroids for preventing postherpetic neuralgia in MEDLINE (1950 to 2006), EMBASE (1980 to 2006), LILACS (1982 to 2005), the Chinese Biomedical Retrieval System (1978 to 2006) and the Cochrane Register of Controlled Trials (CENTRAL) (Cochrane Library Issue 3, 2006). Date of most recent search: September 2006. Selection criteria: Types of studies: quasi-randomised or randomised controlled trials Types of participants: people of all ages with herpes zoster of all degrees of severity within seven days after onset. Types of interventions: all kinds of corticosteroids given by oral, intramuscular or intravenous routes during the acute stage (starting within one week of onset of the rash) compared with no treatment or placebo, but not with other treatments. We also included trials which compared corticosteroids plus routine treatment with placebo plus routine treatment. Types of outcome measures: Primary: the presence of postherpetic neuralgia six months after the onset of the acute herpetic rash. Secondary: pain severity measured by a validated visual analogue scale or numerical descriptive scale after three, six and 12 months; quality of lifemeasured with the short form 36 questionnaire after six months; adverse events during or within two weeks after stopping treatment. Data collection and analysis: Data were extracted by two independent reviewers. Main results: Five trials were included with altogether 787 participants. All were randomised, double-blind, placebo-controlled parallel group studies. Our primary outcome measure was the presence of postherpetic neuralgia six months after the onset of the acute herpetic rash. There was no significant difference between the corticosteroid and control groups for the primary outcome (RR 1.27, 95% CI 0.20 to 7.97). There was also no significant difference between the corticosteroid plus antiviral agents and placebo plus antiviral agents groups for the primary outcome (RR 0.90, 95% CI 0.40 to 2.03). No included trials evaluated pain severity with a validated visual analogue scale or numerical descriptive scale and also no trials measured quality of life with the Short Form 36 questionnaire. Adverse events during or within two weeks after stopping treatment were reported by all five included trials, but after meta-analysis, there was no significant difference in any serious adverse event (death, acute cardiac insufficiency, rash dissemination, bacterial pneumonia or haematemesis) or non serious adverse event (dizziness, nausea, vomiting, hypertension or hyperglycaemia). Authors' conclusions: There was insufficient evidence to conclude that corticosteroids are safe or effective in the prevention of postherpetic neuralgia. More randomised controlled trials with a greater number of participants are needed to determine reliably whether there is real benefit (or harm) from the use of corticosteroid therapy to prevent postherpetic neuralgia. Future trials should measure function and quality of life. Copyright © 2008 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. |
|
|
|
|
|
|
| Correspondence Address: He, L.; Department of Neurology, West China Hospital, Sichuan University, Wai Nan Guo Xue Xiang #37, Chengdu Sichuan 610041, China; email: hlwsy@hotmail.com |
|
|
|
|
|
|
|
|
|
|
|
请登录后发表评论，点击此处登录。
|
|
|
 疾病资源中心
王燕燕 王曙
上海交通大学附属瑞金医院内分泌科
患者，女，69岁。2009年1月无明显诱因下出现乏力，当时程度较轻，未予以重视。2009年3月患者乏力症状加重，尿色逐渐加深，大便习惯改变，颜色变淡。4月18日入我院感染科治疗，诉轻度头晕、心慌，体重减轻10kg。无肝区疼痛，无发热，无腹痛、腹泻、腹胀、里急后重，无恶性、呕吐等。入院半月前于外院就诊，查肝功能：ALT 601IU/L，AST 785IU/L，TBIL 97.7umol/L，白蛋白 41g/L，甲状腺功能：游离T3 30.6pmol/L，游离T4 51.9pmol/L，心电图示快速房颤。
医学数据库
|
