白三烯受体拮抗剂联合鼻用激素治疗变应性鼻炎的系统评价  

Leukotriene receptor antagonist as add-on therapy to intranasal corticosteroids in the treatment of allergic rhinitis:a systematic review

作　　者：冯韶燕[1,2] 樊韵平[2] 李磊[1] 陈默[2] 王运中[2] 许庚 李华斌[1] 

机构地区：[1]上海交通大学医学院附属新华医院耳鼻咽喉头颈外科,上海200092 [2]广东中山大学附属第五医院耳鼻咽喉科中 [3]山大学附属第一医院耳鼻咽喉医院

出　　处：《临床耳鼻咽喉头颈外科杂志》2015年第3期207-211,共5页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

基　　金：国家科技支撑计划项目(No:2014BAI07B00);国家自然科学基金项目(No:81271056)

摘　　要：目的:系统评价白三烯受体拮抗剂(LTRA)联合鼻用激素治疗变应性鼻炎(AR)的临床疗效,为优化AR药物治疗方案提供循证依据。方法:计算机检索OVID、PubMed、EMBASE和Cochrane Library、中国学术期刊全文数据库(CNKI)、万方数据库。检索时限截至2014年5月,纳入有关LTRA联用鼻用激素治疗AR的随机对照实验,经2位研究者独立进行文献筛选、资料提取和方法学质量评价后,采用RevMan 5.1软件进行荟萃(Meta)分析。结果:经检索和筛选,共纳入5个随机对照试验。Meta分析结果显示:鼻用激素加LTRA组的鼻症状总分及流涕、喷嚏症状评分较单用鼻用激素组明显降低[WMD=-4.49,95%CI(-4.95^-4.03),P<0.01;WMD=-0.43,95%CI(-0.78^-0.07),P<0.05;WMD=-0.10,95%CI(-0.16^-0.04),P<0.01];而鼻用激素加LTRA组的鼻塞、鼻痒评分及RQLQ评分与单用鼻用激素组差异无统计学意义[WMD=0.01,95%CI(-0.06~0.08),P>0.05;WMD=-0.15,95%CI(-0.43~0.13),P>0.05;WMD=-15.19,95%CI(-55.37~25.00),P>0.05]。结论:根据目前Meta分析的研究结果,初步认为LTRA联用鼻用激素在治疗AR方面疗效优于单用鼻用激素,且安全性良好,但仍需要今后大样本、多中心的随机对照试验进一步证实。Objective： To systematically evaluate the efficacy and safety of leukotriene receptor antagonist （LTRA） combined intranasal corticosteroids in the treatment of allergic rhinitis （AR）. Method： The randomized controlled trials （RCT） about the combined therapy of LTRA and nasal corticosteroids from January 1985 to May 2014 were searched in OVID, PubMed, EMBASE, CNKI, WanFang Data, and Cochrane Library. Two reviewers in- dependently screened the literatures, extracted the data, and evaluated the methodological quality. Then meta-ana- lyses were conducted by using RevMan 5. 1 software. Result： A total of 5 RCTs were included upon literature search. The results of meta-analyses showed that the efficacy of nasal corticosteroids plus LTRA was superior to nasal corticosteroids alone in total nasal symptom scores and individual nasal symptom scores （rhinorrhea, snee- zing） [WMD=-4.49, 95% CI（--4.95-- --4.03）, P〈0.01; WMD=-0.43, 95% CI（-0. 78----0.07）, P〈 0.05; WMD= -- 0.10 , 95% CI（ --0.16----0.04）, P〈0.01], with significant differences. However, compa- ring the subgroup treated with nasal corticosteroids combined LTRA against the subgroup treated with nasal corti- costeroids alone, we found no significant differences for RQLQ score and for individual nasal symptom scores （na- sal blockage, nasal itching） [WMD=--15.19, 95% CI（--55.37--25.00）, P〉0.05; WMD=0.01, 95% CI（-- 0. 06--0. 08） , P〉0.05; WMD： --0.15, 95% CI（--0. 43--0.13）, P：〉0.05]. Conclusion：Based on limited evi- dence, we preliminary concluded the combined therapy of nasal corticosteroids and LTRA was more effective than nasal corticosteroids alone in the management of AR. Further large-scale, well-designed RCTs were atill requirod to validate the add-on efficacy of LTRA for AR patients.

关 键 词：鼻炎 变应性 白三烯受体拮抗剂 鼻用激素 疗效 Meta分析 

分 类 号：R765.21[医药卫生—耳鼻咽喉科]