按需间断吸入和每日规律吸入糖皮质激素对哮喘患儿安全性和疗效的荟萃分析  

As-needed inhaled corticosteroids vs routine inhaled corticosteroids for asthma children:an evidence-based analysis of safety and efficacy

作　　者：李华斌[1] 罗菲菲[1] 蒋莉[1] 胡波[1] 

机构地区：[1]成都市第五人民医院儿科,成都611130

出　　处：《第二军医大学学报》2014年第4期413-418,共6页Academic Journal of Second Military Medical University

摘　　要：目的系统比较按需间断吸入糖皮质激素和每日规律吸入糖皮质激素两种治疗策略对于哮喘患儿的安全性和有效性。方法通过检索PubMed、Cochrane Library、clinicaltrials.gov以及中国生物医学文献数据库,收集1980年至2013年10月已公开发表的相关文献进行荟萃分析。结果根据关键词检索,共搜索到943篇文献,最终有4篇(5个对比组)平行设计、前瞻性、随机对照临床研究纳入本文荟萃分析。荟萃分析发现,按需间断吸入糖皮质激素(实验组)和每日规律吸入糖皮质激素(对照组)在哮喘加重事件发生率[OR=1.25,95%CI为0.87~1.78,P=0.22]、再住院率(OR=0.85,95%CI为0.28~2.57,P=0.77)、症状和生活质量评分改善[加权均数差(WMD)=0.02,95%CI为-0.19~0.23,P=0.88]、严重不良事件发生率(OR=0.81,95%CI为0.30~2.17,P=0.67)方面差异无统计学意义。然而,对照组呼吸峰值流速改善这一指标高于实验组(WMD=2.76,95%CI为0.69~4.82,P=0.009),而实验组在随访年限中身高的增加平均较对照组高0.51cm(WMD=-0.51,95%CI为-0.87^-0.16,P=0.005)。异质性分析提示各个研究之间同质性较好。结论按需间断吸入糖皮质激素和每日规律吸入糖皮质激素这两种治疗策略对哮喘患儿的疗效无明显差异,每日规律吸入糖皮质激素可以显著改善患儿呼吸峰值流速,但是这一疗法对患儿身高的增长可能有一定的影响。Objective To compare the safety and efficacy of intermittent inhaled corticosteroids （ICS, test group） and routine ICS （control group） treatment strategy for asthma in children. Methods Databases of PubMed, Cochrane Library, clinicaltrials.gov and Chinese Biomedical Literature were searched for relevant studies published from 1980 to 2013. Results Using the predefined key words, we identified 943 citations, and finally 4 parallel-designed, prospective, randomized controlled studies （5 comparison groups） were included in this meta-analysis. We found that there were no significant differences between the two groups in terms of incidence of asthma exacerbations （OR： 1.25,95%CI： 0.87-1.78,P=0.22）, re-hospitalization rate（OR： 0.85, 95%CI：0.28-2.57,P=0.77）, improvement of symptoms and life quality （WMD： 0.02,95%CI： -0.19-0.23,P=0.88）, or incidence of overall severe adverse events （OR： 0.81,95%CI：0.30-2.17,P=0.67）. However, improvement of the peak expiratory flow rate （PEFR） in the control group was significantly greater than that in the test group （WMD： 2.76,95%CI：0.69-4.82, P=0.009）, and the increase of body height in the test group was significantly greater than （by 0.51 cm） that in the control group （WMD：-0.51,95%CI：-0.87--0.16,P=0.005）. Heterogeneity analysis showed that the studies had good homogeneity. Conclusion The as-needed ICS and routine ICS have similar efficacy in treatment of child asthma. Routine ICS can greatly improve the PEFR, but it may have an adverse impact on the body height of Children.

关 键 词：糖皮质激素类 哮喘 吸入投药 儿童 

分 类 号：R725.622.5[医药卫生—儿科]