白三烯受体拮抗剂孟鲁司特治疗变应性鼻炎的荟萃分析  

Meta-analysis of leukotriene receptor antagonist montelukast in the treatment of allergic rhinitis

作　　者：陆忆[1] 殷敏[2,3] 程雷[2,3] 

机构地区：[1]苏州大学附属第三医院耳鼻咽喉科 [2]南京医科大学第一附属医院耳鼻咽喉科,210029 [3]南京医科大学国际变态反应研究中心

出　　处：《中华耳鼻咽喉头颈外科杂志》2014年第8期659-667,共9页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的 评价白三烯受体拮抗剂（leukotriene receptor antagonists,LTRA）单一用药以及与第二代口服抗组胺药联合应用对变应性鼻炎（AR）的治疗结局,为临床优化治疗策略提供参考.方法 搜索PubMed、EMBASE、中国生物医学文献数据库（CBMdisc）和中国期刊全文数据库（CJFD）,检索AR药物治疗的随机对照试验（RCT）文献.依据文献纳入和排除标准,进行文献筛选,采用Jadad量表对纳入文献进行质量评价.用Stata 12.1软件进行荟萃分析,对计量资料计算加权均数差及其95％可信区间,并绘制森林图.采用日间鼻部症状评分（daytime nasal symptom scores,DNSS）、夜间症状评分（nighttime symptom scores,NSS）、综合症状评分（composite symptom scores,CSS）、日间眼部症状评分（daytime eye symptom scores,DESS）以及鼻结膜炎生活质量问卷（rhinoconjunctivitis quality of life questionnaire,RQLQ）评分指标,评价LTRA对季节性和常年性AR的治疗效果.结果 共纳入11项临床RCT,包括14 809例AR患者,年龄15～85岁.主要研究药物为孟鲁司特.荟萃分析显示：①孟鲁司特与安慰剂相比较,能显著降低季节性和常年性AR患者的DNSS、NSS、CSS和RQLQ评分,并能显著降低季节性AR患者的DESS,差异均有统计学意义.②孟鲁司特与氯雷他定比较,在改善季节性AR患者的CSS、DESS和RQLQ评分方面,差异均无统计学意义.③孟鲁司特对季节性AR患者DNSS的改善不如氯雷他定,但对于NSS的改善显著优于氯雷他定,差异均有统计学意义.④联合应用孟鲁司特和氯雷他定对季节性AR患者CSS的改善显著优于单用孟鲁司特或氯雷他定,差异均有统计学意义.结论 孟鲁司特作为LTRA的代表药物,对于AR患者的鼻、眼症状及生活质量具有全面的改善作用,可以作为AR的一线治疗药物.孟鲁司特和氯雷他定联合应用可以更好地改善季节性AR患者的日间和夜间综合症状,其疗效优于单用孟鲁司特或�Objective To evaluate the treatment outcomes of leukotriene receptor antagonists （LTRA） as monotherapy or combined with the second-generation oral H1-histamines in the treatment of allergic rhinitis （AR）,and to provide a basis for optimizing clinical therapeutic strategies.Methods PubMed,EMBASE,CBMdisc and CJFD databases,retrieving randomized controlled trials （RCTs） of AR therapy literatures were searched.Based on the literature inclusion and exclusion criteria,the related literatures were selected and the quality was evaluated by using the Jadad scale.Meta-analysis was performed by Stata 12.1 software.For continuous outcomes,the weighted mean difference （WMD） and its 95％ confidence intervals （CI） were calculated.The forest plots were drawn.The treatment outcomes included daytime nasal symptom scores （DNSS）,nighttime symptom scores （NSS）,composite symptom scores （CSS）,daytime eye symptom scores （DESS）,and the rhinoconjunctivitis quality of life questionnaire （RQLQ） were used to evaluate the therapeutic effects of LTRA on seasonal and perennial AR.Results Eleven of clinical RCTs including 14 809 cases of AR patients,aged 15 to 85 years old,were available for Meta-analysis.Montelukast,a drug of LTRA,was primarily evaluated in the study.The results of Metaanalysis showed：（1） Compared with the placebo,montelukast statistically significantly reduced the DNSS,NSS,CSS,and RQLQ scores in patients with seasonal and perennial AR,as well as the DESS in patients with seasonal AR.（2） There were no statistical differences in the improvement of the CSS,DESS,and RQLQ scores in patients with seasonal AR after the treatment by montelukast compared with loratadine,a secondgeneration oral H1-histamine.（3） Montelukast statistically significantly reduced the NSS,but not DNSS,in patients with seasonal AR compared with loratadine.（4） The combination therapy of montelukast and loratadine statistically significantly improved the CSS compared with either montelukast or loratadine

关 键 词：鼻炎 变应性 季节性 鼻炎 变应性 常年性 白三烯拮抗剂 孟鲁司特 组胺H1拮抗剂 氯雷他定 Meta分析 

分 类 号：R765.21[医药卫生—耳鼻咽喉科]