背景:一些研究比较了硝苯地平与其他保胎药物治疗早产的疗效,但是报告的结果相互矛盾。
目的:比较硝苯地平与利托君的疗效,硝酸甘油和硫酸镁用于早产的管理。
方法:在本系统综述和荟萃分析中,PubMed/MEDLINE,Scopus,ClarivateAnalyticsWebofScience,和GoogleScholar使用预定义的关键字进行搜索,直到2024年4月3日。比较硝苯地平与利托君疗效的随机对照试验(RCT)和临床试验,硝酸甘油和硫酸镁用于管理早产。两位作者独立评论了这些文章,评估其质量并提取数据。纳入随机对照试验的质量基于Cochrane风险偏倚工具1进行临床试验研究。计算风险差异(RD)和相关的95%置信区间(CI)。森林图用于显示硝苯地平和其他保胎药物预防早产的比较点估计值及其基于妊娠延长持续时间的相关95%置信区间。研究异质性通过I2指数进行评估,发表偏倚通过Egger检验进行评估。
结果:纳入了40项纳入4336名女性的研究。根据我们的荟萃分析,硝苯地平组与硝化甘油组之间的前48小时内早产的延长存在显着差异(RD,-0.04;95%CI,-0.08至-0.00;I2:32.3%)。此外,硝苯地平和利托君之间存在显着差异(RD,0.11;95%CI,0.02至0.21;I2,51.2%)超过一周的RD,0.10;95%CI,0.03至0.19;I2,33.2%),持续34周及以上。硝苯地平和硫酸镁之间的差异在四个时间点中的任何一个都不显著。
结论:考虑到硝苯地平优于利托君和硝酸甘油,其在分娩时的疗效与硫酸镁相似,这些选择的副作用似乎决定了第一个药物路线。
BACKGROUND: Some studies have compared the efficacy of nifedipine with that of other tocolytic drugs in the treatment of preterm labor, but the reported results are conflicting.
OBJECTIVE: To compare the efficacy of nifedipine with that of ritodrine, nitroglycerine and magnesium sulfate for the management of preterm labor.
METHODS: In this systematic review and meta-analysis, PubMed/MEDLINE, Scopus, Clarivate Analytics Web of Science, and Google Scholar were searched until April 3,2024 using predefined keywords. Randomized controlled trials (RCTs) and clinical trials that compared the efficacy of nifedipine with that of ritodrine, nitroglycerine and magnesium sulfate for the management of preterm labor were included. Two authors independently reviewed the articles, assessed their quality and extracted the data. The quality of the included RCTs based on the Cochrane Risk of Bias Tool 1 for clinical trial studies. The risk difference (RD) with the associated 95% confidence interval (CI) was calculated. A forest plot diagram was used to show the comparative point estimates of nifedipine and other tocolytic drugs on the prevention of preterm labor and their associated 95% confidence intervals based on the duration of pregnancy prolongation. Study heterogeneity was evaluated by the I2 index, and publication bias was evaluated by Egger\'s test.
RESULTS: Forty studies enrolling 4336 women were included. According to our meta-analysis, there was a significant difference in the prolongation of preterm labor within the first 48 h between the nifedipine group and the nitroglycerine group (RD, -0.04; 95% CI, -0.08 to -0.00; I2: 32.3%). Additionally, there were significant differences between nifedipine and ritodrine (RD, 0.11; 95% CI, 0.02 to 0.21; I2, 51.2%) for more than one week RD, 0.10; 95% CI, 0.03 to 0.19; I2, 33.2%) and for 34 weeks and more. The difference between nifedipine and magnesium sulfate was not significant in any of the four time points.
CONCLUSIONS: Considering the superiority of nifedipine over ritodrine and nitroglycerine and its similar efficacy to magnesium sulfate for
tocolysis, it seems that the side effects of these options determine the first drug line.