大环内酯类作为抗炎药治疗社区获得性肺炎与呼吸机相关性肺炎：系统综述与荟萃分析
该系统综述与荟萃分析纳入13项研究（其中9项进入荟萃分析），评估大环内酯类作为抗炎药在社区获得性肺炎（CAP）和呼吸机相关性肺炎（VAP）中的疗效。荟萃分析显示大环内酯类使用与院内死亡率（OR 0.42，95%CI 0.25-0.71）和出院后死亡率（OR 0.52，95%CI 0.31-0.87）显著降低相关，住院时长非显著减少（MD -0.68，95%CI -1.67至0.32）。作者指出RCT数量有限降低证据质量，需更多高质量RCT证实。
要点
- 大环内酯类作为抗炎药与CAP/VAP患者院内死亡率显著降低相关（OR 0.42）。
- 出院后死亡率亦显著降低（OR 0.52），住院时长呈非显著减少趋势。
- RCT数量有限，整体证据质量受影响，需进一步高质量RCT验证。
核心结论
- 大环内酯类在CAP和VAP中显示出潜在抗炎获益，可改善临床结局。
- 需进一步设计良好的RCT来强化证据并确认这些发现。
研究设计与样本
- 系统综述与荟萃分析，检索获得11960条记录，13项研究符合纳入标准进入定性综合。
- 其中9项研究进入荟萃分析，纳入观察性研究、非随机研究和随机对照试验（RCT）。
- 采用PICOS框架定义研究合格性，由三名独立评审员按Cochrane指南筛选。
- 该综述在PROSPERO注册（CRD42018088203）。
主要发现
- 荟萃分析显示大环内酯类使用与院内死亡率显著降低相关（OR 0.42，95%CI 0.25-0.71）。
- 出院后死亡率亦显著降低（OR 0.52，95%CI 0.31-0.87）。
- 住院时长呈非显著减少（MD -0.68，95%CI -1.67至0.32）。
- 纳入荟萃分析的研究中25%为低偏倚风险，约50%为中等偏倚风险。
临床怎么用
- 在遵循治疗指南的前提下，可考虑大环内酯类作为CAP和VAP的抗炎辅助治疗以改善死亡率相关结局。
- 临床决策需结合RCT数量有限导致的证据质量限制，个体化评估获益与风险。
局限性
- RCT数量有限，降低了可用证据的整体质量。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
Syst Rev. 2026 May 6;15(1):193. doi: 10.1186/s13643-026-03190-1. ABSTRACT BACKGROUND: Community-acquired pneumonia (CAP) and ventilator-associated pneumonia (VAP) require effective treatment strategies. In addition to their antimicrobial role, macrolides may have a potential anti-inflammatory role in CAP and VAP. The purpose of this systematic review is to explore the use of macrolides as anti-inflammatory drugs in CAP and VAP and to assess their impact on mortality and hospital length of stay while adhering to treatment guidelines. METHODS: A comprehensive search was conducted. Inclusion criteria were determined based on the PICOS (Population, Intervention, Comparison, Outcome, and Study Design) framework. The PICOS framework was used to define study eligibility and was not applied as a weighting or scoring system. Only observational studies, non-randomized studies, and randomized controlled trials (RCTs) meeting these criteria were included. A standardized eligibility screening form was employed by three independent reviewers, adhering to the established Cochrane guidelines and utilizing specialized software for analysis. RESULTS: Among 11,960 identified records, 13 studies met the inclusion criteria and underwent qualitative synthesis. Nine studies underwent meta-analysis. Of these, 25% exhibited a low risk of bias, and approximately 50% presented a moderate risk of bias. Meta-analysis showed that macrolide's use was associated with a significant reduction in in-hospital mortality (OR 0.42, 95% CI 0.25-0.71) and post-discharge mortality (OR 0.52, 95% CI 0.31-0.87). A non-significant reduction in length of hospital stay was also observed (MD - 0.68, 95% CI - 1.67 to 0.32). However, the limited number of RCTs reduces the overall quality of the available evidence. CONCLUSIONS: Macrolides demonstrate potential anti-inflammatory benefits in CAP and VAP, leading to improved clinical outcomes. However, further well-designed RCTs are needed to strengthen the evidence and confirm these findings. SYSTEMATIC REVIEW REGISTRATION: This review was registered in PROSPERO (registration number: CRD42018088203). PMID: 42087250 | PMC: PMC13312718 | DOI: 10.1186/s13643-026-03190-1
引用
- PubMed 高证据 · 肺炎：Macrolides usage as anti-inflammatory agents in the treatment of community-acquired pneumonia and ventilator-associated pneumonia: a systematic review and meta-analysis
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。