SARS: systematic review of treatment effects.
SARS: systematic review of treatment effects.
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DOI：
10.1371/journal.pmed.0030343
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发表时间：
2006-09
期刊：
影响因子：
15.8
通讯作者：
Garner P
中科院分区：
文献类型：
--
作者：
Stockman LJ;Bellamy R;Garner P
2002-2003 年爆发的 SARS 给临床医生带来了一种新的危及生命的疾病，他们对此没有治疗经验，也没有对治疗方案的有效性进行研究。世界卫生组织（WHO）SARS治疗专家组要求对SARS感染患者的治疗方法进行系统回顾和全面总结，以指导未来的治疗并确定研究重点。应世界卫生组织的要求，我们对来自体外研究和 SARS 患者的利巴韦林、皮质类固醇、洛匹那韦和利托那韦 (LPV/r)、I 型干扰素 (IFN)、静脉注射免疫球蛋白 (IVIG) 和 SARS 恢复期血浆的已发表文献进行了系统回顾。我们还寻找了治疗急性呼吸窘迫综合征的临床试验证据。数据来源是截至 2005 年 2 月的文献数据库 MEDLINE、EMBASE、BIOSIS 和 Cochrane 对照试验中央注册库 (CENTRAL)。从出版物中提取数据，并使用预定义的标准对研究中的证据进行分类。总共有 54 项 SARS 治疗研究、15 项体外研究和 3 项急性呼吸窘迫综合征研究符合我们的纳入标准。在体外研究中，利巴韦林、洛匹那韦和 I 型干扰素在组织培养中显示出对 SARS-CoV 的抑制作用。在 SARS 感染患者关于利巴韦林的报告中，有 26 项研究被归类为不确定，其中 4 项研究显示可能存在危害。七项针对恢复期血浆或 IVIG 的研究、三项针对 I 型 IFN 的研究以及两项针对 LPV/r 的研究均未得出结论。在 29 项类固醇使用研究中，25 项尚无结论，其中 4 项被归类为可能造成伤害。尽管有大量关于 SARS 治疗的文献报道，但无法确定治疗是否对 SARS 爆发期间的患者有益。有些可能是有害的。临床试验的设计应旨在验证剂量和时间的标准方案，并在未来爆发期间实时积累数据，以监测特定的不良反应并帮助为治疗提供信息。应世界卫生组织SARS专家小组的要求，对报告的SARS感染患者的治疗方法进行系统审查和全面总结，但无法确定任何治疗方法是否对患者有益。严重急性呼吸系统综合症（SARS）是由病毒引起的；主要症状是肺炎和发烧。该病毒通常在人们打喷嚏或咳嗽时传播。 2003 年，SARS 成为人们广泛谈论的疾病，当时全世界出现了 8,000 多例病例，774 人死亡。这种情况令人震惊，因为首例病例于 2002 年才在中国出现，因此治疗这种新疾病的最佳方法尚不清楚。对病毒有效的药物并不多，医生通常对病毒性疾病所能做的就是治疗特定症状（例如发烧和炎症）并依靠人体自身的免疫系统来抵抗病毒本身。然而，近年来，已经开发出许多抗病毒药物（例如，有几种用于治疗艾滋病毒/艾滋病），因此人们希望其中一些药物可能对非典有效。类固醇也经常用于 SARS 治疗，以试图减少肺部炎症。为了找出哪些（如果有的话）潜在的 SARS 治疗方法是有效的，在最近爆发期间和爆发后进行了许多研究。医疗保健决策应基于所有可获得的信息。尝试将每种可能的疾病治疗方法的所有可靠证据汇集在一起非常重要。这样做的过程称为系统审查。 2003年10月，世界卫生组织（WHO）成立了国际SARS治疗研究组，由具有治疗SARS患者经验的专家组成。该小组建议对 SARS 的潜在治疗方法进行系统审查。特别是，总结关于使用某些抗病毒药物（利巴韦林、洛匹那韦和利托那韦）、类固醇和称为免疫球蛋白的蛋白质（这些药物天然存在于人体血液中）的现有证据被认为很重要。世卫组织小组想知道这些治疗如何影响体外（“体外”）病毒，以及它们是否有助于改善患者状况并降低死亡率，特别是那些出现急性呼吸窘迫综合征（ARDS）危险并发症的患者。本研究是应世界卫生组织要求进行的系统评价。他们没有对患者或实验室进行新的工作。相反，他们对科学和医学文献进行了全面的搜索，以寻找符合他们精心设定的选择标准的已发表研究。他们发现 54 项 SARS 治疗研究、15 项体外研究和 3 项 ARDS 研究符合这些标准。一些抗病毒药物的体外研究发现，某种特定的药物可以降低病毒的繁殖率，但大多数这些药物在患者身上的研究都没有得出结论。在 29 项关于类固醇使用的研究中，25 项没有得出结论，其中 4 项发现这种治疗可能会造成伤害。从已发表的研究来看，不可能说针对 SARS 的任何治疗方法是否有效。自 2004 年以来，没有报告过 SARS 病例，但相同或相似的病毒始终有可能在未来引起疫情爆发。令人失望的是，所有关于 SARS 的研究都不可能有助于确定应对此类疫情的最佳治疗方法。作者讨论了他们发现的研究的弱点，并敦促在未来任何类似的疫情爆发中及时应用更有效的研究方法。虽然系统评价表明，我们不知道哪种潜在的 SARS 治疗方法有效，但其建议意味着研究人员至少应该做好更好的准备，从未来潜在的疫情中吸取教训。请通过此摘要的在线版本访问这些网站：http://dx.doi.org/10.1371/journal.pmed.0030343。 有关 SARS 的维基百科条目（维基百科是任何人都可以编辑的免费在线百科全书） 有关 SARS 的 MedlinePlus 页面 有关系统评论的维基百科条目，其中包括指向其他网站的链接，在这些网站上可以找到更详细的信息
The SARS outbreak of 2002–2003 presented clinicians with a new, life-threatening disease for which they had no experience in treating and no research on the effectiveness of treatment options. The World Health Organization (WHO) expert panel on SARS treatment requested a systematic review and comprehensive summary of treatments used for SARS-infected patients in order to guide future treatment and identify priorities for research. In response to the WHO request we conducted a systematic review of the published literature on ribavirin, corticosteroids, lopinavir and ritonavir (LPV/r), type I interferon (IFN), intravenous immunoglobulin (IVIG), and SARS convalescent plasma from both in vitro studies and in SARS patients. We also searched for clinical trial evidence of treatment for acute respiratory distress syndrome. Sources of data were the literature databases MEDLINE, EMBASE, BIOSIS, and the Cochrane Central Register of Controlled Trials (CENTRAL) up to February 2005. Data from publications were extracted and evidence within studies was classified using predefined criteria. In total, 54 SARS treatment studies, 15 in vitro studies, and three acute respiratory distress syndrome studies met our inclusion criteria. Within in vitro studies, ribavirin, lopinavir, and type I IFN showed inhibition of SARS-CoV in tissue culture. In SARS-infected patient reports on ribavirin, 26 studies were classified as inconclusive, and four showed possible harm. Seven studies of convalescent plasma or IVIG, three of IFN type I, and two of LPV/r were inconclusive. In 29 studies of steroid use, 25 were inconclusive and four were classified as causing possible harm. Despite an extensive literature reporting on SARS treatments, it was not possible to determine whether treatments benefited patients during the SARS outbreak. Some may have been harmful. Clinical trials should be designed to validate a standard protocol for dosage and timing, and to accrue data in real time during future outbreaks to monitor specific adverse effects and help inform treatment. A systematic review and comprehensive summary of reported treatments of SARS-infected patients, requested by the WHO expert panel on SARS, could not determine whether any treatments benefited patients. Severe acute respiratory syndrome (SARS) is caused by a virus; the main symptoms are pneumonia and fever. The virus is usually passed on when people sneeze or cough. SARS became a much-talked about disease in 2003, when over 8,000 cases and 774 deaths occurred worldwide. The situation was alarming, because the first-ever cases had only just appeared in 2002, in China, so the best way to treat this new disease was unknown. Not many drugs are effective against viruses, and all doctors can usually do with a viral disease is to treat specific symptoms (e.g., fever and inflammation) and rely on the body's own immune system to fight off the virus itself. However, in recent years a number of antiviral drugs have been developed (for example, several are in use against HIV/AIDS), so there was hope that some of them might be active against SARS. Steroids were also often used in SARS treatment to try to reduce the inflammation of the lungs. In order to find out which, if any, of the potential treatments for SARS were effective, a number of research studies were carried out, both during and since the recent outbreak. Health care decisions should be based on all the information that is available. It is important to try to bring together all the reliable evidence that exists on each possible treatment for a disease. The process of doing so is called a systematic review. In October 2003 the World Health Organization (WHO) established an International SARS Treatment Study Group, consisting of experts experienced in treating patients with SARS. The group recommended a systematic review of potential treatments for SARS. In particular, it was considered important to summarise the available evidence on the use of certain antiviral drugs (ribavirin, lopinavir, and ritonavir), steroids, and proteins called immunoglobulins, which are found naturally in human blood. The WHO group wanted to know how these treatments affected the virus outside the body (“in vitro”) and whether it helped the condition of patients and reduced the death rate, particularly in those patients who developed the dangerous complication called acute respiratory distress syndrome (ARDS). This study is a systematic review conducted in response to the WHO request. They did no new work with patients or in the laboratory. Instead they conducted a comprehensive search of the scientific and medical literature for published studies that fitted their carefully predefined selection criteria. They found 54 SARS treatment studies, 15 in vitro studies, and three ARDS studies that met these criteria. Some of the in vitro studies with the antiviral drugs found that a particular drug reduced the reproduction rate of the viruses, but most of the studies of these drugs in patients were inconclusive. Of 29 studies on steroid use, 25 were inconclusive and four found that the treatment caused possible harm. From the published studies, it is not possible to say whether any of the treatments used against SARS were effective. No cases of SARS have been reported since 2004 but it is always possible that the same or a similar virus might cause outbreaks in the future. It is disappointing that none of the research on SARS is likely to be useful in helping to decide on the best treatments to use in such an outbreak. The authors discuss the weaknesses of the studies they found and urge that more effective methods of research be applied, in a timely fashion, in any similar outbreaks in the future. While the systematic review suggests that we do not know which if any of the potential treatments against SARS are effective, its recommendations mean that researchers should at least be better prepared to learn from potential future outbreaks. Please access these Web sites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.0030343. Wikipedia entry on SARS (Wikipedia is a free online encyclopedia that anyone can edit) MedlinePlus pages on SARS Wikipedia entry on systematic reviews, which includes links to other Web sites where more detailed information may be found
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DOI：
10.1016/s0140-6736(03)13077-2
发表时间：
2003-04-19
期刊：
Lancet (London, England)
影响因子：
--
作者：
Peiris JS;Lai ST;Poon LL;Guan Y;Yam LY;Lim W;Nicholls J;Yee WK;Yan WW;Cheung MT;Cheng VC;Chan KH;Tsang DN;Yung RW;Ng TK;Yuen KY;SARS study group
通讯作者：
SARS study group
影响因子：
39.2
作者：
Leung, GM;Hedley, AJ;Lam, TH
通讯作者：
Lam, TH
影响因子：
11.8
作者：
Knowles, SR;Phillips, EJ;Matukas, L
通讯作者：
Matukas, L
影响因子：
120.7
作者：
Fowler, RA;Lapinsky, SE;Stewart, TE
通讯作者：
Stewart, TE
影响因子：
10
作者：
Chu, CM;Cheng, VCC;Yuen, KY
通讯作者：
Yuen, KY