The Value Of Cerebrospinal Fluid Replacement Plus Intrathecal Isoniazid And Dexamethasone In The Treatment Of Tuberculous Meningitis——a Meta-analysis

Objectives:Observe the advantages and characteristics of adjunctive cerebrospinal fluid replacement plus intrathecal isoniazid and dexamethasone therapy in the treatment of tuberculous meningitis compared with traditional therapy alone by the means of meta-analysis. Determine the value of this adjunctive therapy and provide evidence to make the treatment of tuberculous meningitis more optimal.Materials and Methods:We searched the Chinese Journal Full-text Database, Pubmed Database, Cochrane Collaboration Database, and SCI Database for RCTs that compared adjunctive cerebrospinal fluid replacement plus intrathecal isoniazid and dexamethasone therapy with traditional therapy alone in the patients with tuberculous meningitis. The RCTs were filtered by inclusion and exclusion criteria, and the qualities were evaluated. Meta-analysis was made to compare the cure rate, mortality rate, and sequelae rate. The adverse events were also recorded. Review Manager5.0was used to do the meta-analysis. The results were presented by RR and95%CI form for dichotomous data, x2test was used for heterogeneity tests. If P≥0.05and I2≤50%, fixed effect model was applied. Otherwise random effect model or subgroup analysis would be used.Results:Sixteen articles published from2001to2010, including1108patients with580in the observe group and528in the control group, were eligible. Higher cure rate (RR=1.41,95%CI1.27—1.57, P<0.00001), lower mortality rate (RR=0.37,95%CI0.2—0.67, P=0.001), and lower sequelae rate (RR=0.65,95%CI0.49—0.86, P=0.003) were achieved by the adjunctive cerebrospinal fluid replacement plus intrathecal isoniazid and dexamethasone group. But some adverse events had also been observed.Conclusions:The use of adjunctive cerebrospinal fluid replacement plus intrathecal isoniazid and dexamethasone therapy results in higher cure rate, lower mortality rate, and less sequelaes. This therapy is effective for patients with tuberculous meningitis, especially late stage tuberculous meningitis.