去氨加压素、警铃及联合方案治疗儿童单症状夜遗尿症疗效的网状meta 分析

doi:10.3969/j.issn.1000-3606.2019.01.014

临床儿科杂志 ›› 2019, Vol. 37 ›› Issue (1): 55-62.doi: 10.3969/j.issn.1000-3606.2019.01.014

去氨加压素、警铃及联合方案治疗儿童单症状夜遗尿症疗效的网状meta 分析

徐晓楠，惠疆锦，陈菁华，等

1.兰州大学第二医院　甘肃省儿童医院儿内科（甘肃兰州　730000）；2.兰州大学第一临床医学院临床医学（甘肃兰州　730000）；3.兰州大学第二临床医学院临床医学（甘肃兰州　730000）

出版日期:2019-01-15 发布日期:2019-02-01
基金资助:
徐晓楠　电子信箱：ldeyxxn@163.com

A network meta-analysis of desmopressin, alarm, and combination of both in the treatment of monosymptomatic nocturnal enuresis in children

XU Xiaonan, HUI Jiangjin, CHEN Jinghua, et al

1.Department of Pediatrics, Children’s Hospital of Gansu Province, The Second Hospital of Lanzhou University, Gansu 730000, Lanzhou, China; 2.School of Clinical Medicine, The First Hospital of Lanzhou University, Lanzhou, 730000, Gansu China; 3. School of Clinical Medicine, The Second Hospital of Lanzhou University, Lanzhou 730000, Gansu, China

Online:2019-01-15 Published:2019-02-01

摘要/Abstract

摘要： 目的　采用网状meta分析方法系统性评价去氨加压素、警铃、去氨加压素联合警铃、去氨加压素联合抗胆碱能药物4种干预措施治疗儿童单症状夜遗尿的疗效。方法　系统检索PubMed、Cochrance Library、 EMBase和Web of Science数据库，时间截止到2017年8月1日。纳入对比去氨加压素、警铃、去氨加压素联合警铃、去氨加压素联合抗胆碱能药物中任意2个或以上干预措施治疗儿童单症状夜遗尿症的随机对照试验（RCT）。按照制定好的纳入排除标准进行文献筛选，对最终纳入的RCT进行数据提取和质量评价，利用统计软件R 3.3.2和STATA 14.0完成数据分析。结果　纳入 15个RCT，共计1 505例患儿。网状meta分析提示，去氨加压素联合抗胆碱能药物的完全反应率和成功率高于去氨加压素（完全反应率OR=2.8，95%CI：1.5~5.4；成功率OR=3.5，95%CI：1.7~7.5）和警铃（完全反应率OR=2.7，95%CI：1.1~6.6；成功率OR=3.8，95%CI:1.6~9.0）；去氨加压素联合警铃成功率高于警铃（OR=1.9，95%CI：1.1~3.4）；治疗结束后警铃的复发率明显低于去氨加压素（OR=0.15，95%CI：0.03~0.53）。排序结果显示，去氨加压素联合抗胆碱能药物治疗后的完全反应率和成功率治疗效果最佳，去氨加压素联合警铃能最大程度降低每周尿床次数，警铃的复发率在4种方案中最低。结论　去氨加压素联合抗胆碱能药物治疗效果明显好于单用警铃或去氨加压素；去氨加压素联合警铃方案比单用警铃或去氨加压素治疗效果略有优势或相近；去氨加压素和警铃治疗效果相近；警铃治疗的复发率最低。

关键词: 单症状夜遗尿症；　去氨加压素；　警铃；　抗胆碱能药物；　网状mate分析；　儿童

Abstract: Objective　To systematically explore the efficacy of four intervention regiments including desmopressin, alarm, desmopressin combined with alarm, and desmopressin combined with anticholinergic drugs in the treatment of monosymptomatic nocturnal enuresis in children by network meta-analysis. Methods　The databases of PubMed, Cochrance Library, EMBase and Web of Science were systematically searched and retrieved upto August 1, 2017. Included were the randomized controlled trials (RCTs) which had any two or more of four intervention regiments (desmopressin, alarm, desmopressin combined with alarm, and desmopressin combined with anticholinergic drugs) for treatment of monosymptomatic nocturnal enuresis in children. The literature was screened according to the established inclusion and exclusion criteria, and the data extraction and quality evaluation were performed for the final inclusion of RCT. Software R 3.3.2 and STATA 14.0 were used for data analysis. Results　Fifteen RCTs were included with a total of 1505 children. Network meta-analysis showed that the complete response rate and success rate of desmopressin combined with anticholinergic drugs were higher than those of desmopressin (complete reaction rate: OR=2.8, 95% CI :1.5~5.4; success rate: OR=3.5, 95% CI :1.7~7.5) and alarm (complete response rate: OR=2.7, 95% CI :1.1~6.6; success rate: OR=3.8, 95% CI: 1.6~9.0. The success rate of desmopressin combined with alarm was higher than that of alarm (OR=1.9, 95%CI: 1.1~3.4). The recurrence rate of alarm after treatment was significantly lower than that of desmopressin (OR=0.15, 95%CI: 0.03~0.53). The ranking results showed that the complete response rate and success rate of desmopressin combined with anticholinergic drugs were the best. The desmopressin combined with alarm can minimize the number of bed-wetting episodes per week and the recurrence rate of alarm was the lowest among the four regiments. Conclusion　The effect of desmopressin combined with anticholinergic drugs is significantly better than that of alarm or desmopressin alone. The combination of desmopressin and alarm has a slight advantage or similar effect to that of single alarm or desmopressin treatment. The effect of desmopressin is similar to that of alarm. Alarm treatment has the lowest recurrence rate.

Key words: monosymptomatic nocturnal enuresis;　desmopressin;　alarm;　anticholinergic agent;　network metaanalysis;　child

徐晓楠1，惠疆锦2，陈菁华2，杜丽雅3，张妮1，马汉伟1. 去氨加压素、警铃及联合方案治疗儿童单症状夜遗尿症疗效的网状meta 分析[J]. 临床儿科杂志, 2019, 37(1): 55-62.

　XU Xiaonan1, HUI Jiangjin2, CHEN Jinghua2, DU Liya3, ZHANG Ni1, MA Hanwei1. A network meta-analysis of desmopressin, alarm, and combination of both in the treatment of monosymptomatic nocturnal enuresis in children[J]. Journal of Clinical Pediatrics, 2019, 37(1): 55-62.

去氨加压素、警铃及联合方案治疗儿童单症状夜遗尿症疗效的网状meta 分析

A network meta-analysis of desmopressin, alarm, and combination of both in the treatment of monosymptomatic nocturnal enuresis in children

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