神经氨酸酶抑制剂对甲型H1N1pdm09流感相关肺炎的影响：一项个体参与者数据的荟萃分析
Impact of neuraminidase inhibitors on influenza A(H1N1)pdm09-related pneumonia: an individual participant data meta-analysis.
作者信息
Muthuri Stella G, Venkatesan Sudhir, Myles Puja R, Leonardi-Bee Jo, Lim Wei Shen, Al Mamun Abdullah, Anovadiya Ashish P, Araújo Wildo N, Azziz-Baumgartner Eduardo, Báez Clarisa, Bantar Carlos, Barhoush Mazen M, Bassetti Matteo, Beovic Bojana, Bingisser Roland, Bonmarin Isabelle, Borja-Aburto Victor H, Cao Bin, Carratala Jordi, Cuezzo María R, Denholm Justin T, Dominguez Samuel R, Duarte Pericles A D, Dubnov-Raz Gal, Echavarria Marcela, Fanella Sergio, Fraser James, Gao Zhancheng, Gérardin Patrick, Giannella Maddalena, Gubbels Sophie, Herberg Jethro, Higuera Iglesias Anjarath L, Hoeger Peter H, Hoffmann Matthias, Hu Xiaoyun, Islam Quazi T, Jiménez Mirela F, Kandeel Amr, Keijzers Gerben, Khalili Hossein, Khandaker Gulam, Knight Marian, Kusznierz Gabriela, Kuzman Ilija, Kwan Arthur M C, Lahlou Amine Idriss, Langenegger Eduard, Lankarani Kamran B, Leo Yee-Sin, Linko Rita, Liu Pei, Madanat Faris, Manabe Toshie, Mayo-Montero Elga, McGeer Allison, Memish Ziad A, Metan Gokhan, Mikić Dragan, Mohn Kristin G I, Moradi Ahmadreza, Nymadawa Pagbajabyn, Ozbay Bulent, Ozkan Mehpare, Parekh Dhruv, Paul Mical, Poeppl Wolfgang, Polack Fernando P, Rath Barbara A, Rodríguez Alejandro H, Siqueira Marilda M, Skręt-Magierło Joanna, Talarek Ewa, Tang Julian W, Torres Antoni, Törün Selda H, Tran Dat, Uyeki Timothy M, van Zwol Annelies, Vaudry Wendy, Velyvyte Daiva, Vidmar Tjasa, Zarogoulidis Paul, Nguyen-Van-Tam Jonathan S
机构信息
Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK.
Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK.
出版信息
Influenza Other Respir Viruses. 2016 May;10(3):192-204. doi: 10.1111/irv.12363. Epub 2016 Feb 1.
BACKGROUND
The impact of neuraminidase inhibitors (NAIs) on influenza-related pneumonia (IRP) is not established. Our objective was to investigate the association between NAI treatment and IRP incidence and outcomes in patients hospitalised with A(H1N1)pdm09 virus infection.
METHODS
A worldwide meta-analysis of individual participant data from 20 634 hospitalised patients with laboratory-confirmed A(H1N1)pdm09 (n = 20 021) or clinically diagnosed (n = 613) 'pandemic influenza'. The primary outcome was radiologically confirmed IRP. Odds ratios (OR) were estimated using generalised linear mixed modelling, adjusting for NAI treatment propensity, antibiotics and corticosteroids.
RESULTS
Of 20 634 included participants, 5978 (29·0%) had IRP; conversely, 3349 (16·2%) had confirmed the absence of radiographic pneumonia (the comparator). Early NAI treatment (within 2 days of symptom onset) versus no NAI was not significantly associated with IRP [adj. OR 0·83 (95% CI 0·64-1·06; P = 0·136)]. Among the 5978 patients with IRP, early NAI treatment versus none did not impact on mortality [adj. OR = 0·72 (0·44-1·17; P = 0·180)] or likelihood of requiring ventilatory support [adj. OR = 1·17 (0·71-1·92; P = 0·537)], but early treatment versus later significantly reduced mortality [adj. OR = 0·70 (0·55-0·88; P = 0·003)] and likelihood of requiring ventilatory support [adj. OR = 0·68 (0·54-0·85; P = 0·001)].
CONCLUSIONS
Early NAI treatment of patients hospitalised with A(H1N1)pdm09 virus infection versus no treatment did not reduce the likelihood of IRP. However, in patients who developed IRP, early NAI treatment versus later reduced the likelihood of mortality and needing ventilatory support.
背景
神经氨酸酶抑制剂（NAIs）对流感相关肺炎（IRP）的影响尚未明确。我们的目的是研究NAI治疗与甲型H1N1流感大流行病毒感染住院患者IRP发生率及预后之间的关联。
方法
对20634例住院患者的个体参与者数据进行全球荟萃分析，这些患者经实验室确诊为甲型H1N1流感大流行（n = 20021）或临床诊断为“大流行性流感”（n = 613）。主要结局是经影像学证实的IRP。使用广义线性混合模型估计比值比（OR），并对NAI治疗倾向、抗生素和皮质类固醇进行校正。
结果
在纳入的20634名参与者中，5978名（29.0%）患有IRP；相反，3349名（16.2%）经证实无影像学肺炎（对照）。症状出现后2天内早期NAI治疗与未进行NAI治疗相比，与IRP无显著关联[校正OR 0.83（95%CI 0.64 - 1.06；P = 0.136）]。在5978例患有IRP的患者中，早期NAI治疗与未治疗相比，对死亡率[校正OR = 0.72（0.44 - 1.17；P = 0.180）]或需要通气支持的可能性[校正OR = 1.17（0.71 - 1.92；P = 0.537）]没有影响，但早期治疗与延迟治疗相比，显著降低了死亡率[校正OR = 0.70（0.55 - 0.88；P = 0.003）]和需要通气支持的可能性[校正OR = 0.68（0.54 - 0.85；P = 0.001）]。
结论
甲型H1N1流感大流行病毒感染住院患者早期NAI治疗与未治疗相比，并未降低IRP的发生可能性。然而，在发生IRP的患者中，早期NAI治疗与延迟治疗相比，降低了死亡可能性和需要通气支持的可能性。
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