长期小剂量红霉素对慢性阻塞性肺疾病稳定期作用的Meta分析  

Effects of Low-dose Erythromycin on Patients with Stable COPD: A Meta-Analysis

作　　者：凤婧[1] 汤小菊[2] 陈一帆[1] 梁娅莎 袁莉[3] 罗凤鸣[1] 

机构地区：[1]四川大学华西医院呼吸内科,成都610041 [2]四川大学再生医学中心,成都610041 [3]四川大学华西临床医学院,成都610041

出　　处：《中国循证医学杂志》2014年第2期191-196,共6页Chinese Journal of Evidence-based Medicine

基　　金：国家自然科学基金资助项目(编号:30871118;30971325;81270129)

摘　　要：目的系统评价小剂量红霉素治疗慢性阻塞性肺疾病(COPD)稳定期的临床疗效。方法计算机检索PubMed、EMbase、CBM、The Cochrane Library(2013年第4期)、CNKI、VIP和WanFang Data,查找小剂量红霉素+常规治疗与常规治疗或安慰剂加常规治疗比较治疗COPD稳定期患者疗效的随机对照试验(RCT)。检索时限均从建库至2013年5月。由2位评价员按照纳入与排除标准独立筛选文献、提取资料和评价纳入研究的方法学质量后,采用RevMan 5.2软件进行Meta分析。结果最终纳入8个RCT,共计526例患者。Meta分析结果显示:①与对照组相比,小剂量红霉素可显著改善COPD稳定期患者6分钟步行距离[SMD=0.30,95%CI(0.05,0.55),P=0.02],减少患者急性发作频率[RR=0.44,95%CI(0.25,0.78),P=0.005],降低痰中IL-8[SMD=–1.63,95%CI(–2.17,–1.09),P<0.00001]、TNF-α[SMD=–1.49,95%CI(–2.36,–0.62),P=0.0008]及中性粒细胞弹性蛋白酶[SMD=–0.94,95%CI(–1.36,–0.51),P<0.0001]水平。②两组在改善COPD稳定期患者第一秒用力呼气容积(FEV1)值方面无明显差异[SMD=0.19,95%CI(–0.19,0.58),P=0.32]。结论在COPD稳定期,小剂量红霉素的应用可改善患者运动耐量、减少急性加重频率、减轻气道炎症,但不能较常规治疗显著改善患者的肺功能。受纳入研究数量和质量限制,上述结论尚有赖于进一步开展更多大样本、多中心、高质量的RCT加以验证。Objective To systematically review the clinical efficacy of low-dose erythromycin in patients with stable chronic obstructive pulmonary disease （COPD）. Methods Randomized controlled trials （RCTs） about low-dose erythromycin plus routine treatment versus routine treatment/placebo plus routine treatment in treating stable COPD was electronically searched in PubMed, EMbase, CBM, The Cochrane Library （Issue 4, 2013）, CNKI, VIP and WanFang Data from the their establishment dates to May 2013. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed methodological quality. The results of meta-analysis was performed using RevMan 5.2 software. Results A total of eight RCTs involving 526 patients were finally included. The results of metaanalysis showed that： a） compared with the control group, low-dose erythromycin significantly improved six-minute walk distance （SMD=0.30, 95%CI 0.05 to 0.55, P=0.02）, reduced the frequency of acute exacerbation （RR=0.44, 95%CI 0.25 to 0.78, P=0.005）, and decreased the concentrations of IL-8 （SMD= -1.63, 95%CI -2.17 to -1.09, P〈0.000 01）, TNF-α （SMD= -1.49, 95%CI -2.36 to -0.62, P=0.000 8）, and neutrophil elastase （NE） （SMD= -0.94, 95%CI -1.36 to -0.51, P〈0.000 1） in sputum. b） the erythromycin therapy could improve forced expiratory volume in one second （FEV1） （SMD=0.19, 95%CI -0.19 to 0.58, P=0.32） but without significant differences compared with the control group. Conclusion Low-dose erythromycin could improve exercise tolerance, reduce the frequency of acute exacerbation, and help relieve airway inflammation, but in the improvement of FEVI, low-dose erythromycin is not better than routine treatment. Due to limited quantity and quality of the included studies, larger scale, multicenter, high quality RCTs are needed to verify the aforementioned conclusion.

关 键 词：慢性阻塞性肺疾病 小剂量红霉素 META分析 随机对照试验 

分 类 号：R563.9[医药卫生—呼吸系统]