H_(1)受体拮抗剂治疗儿童变态反应性疾病的指南与共识:一项评价研究  

Guidelines and consensuses evaluation of H_(1)-antihistamines in the treatment of allergic diseases in children:an evaluation and review

作　　者：周欣[1] 周鹏翔[2,3] 周薇 翟所迪[2,3] ZHOU Xin;ZHOU Peng-xiang;ZHOU Wei;ZHAI Suo-di(Department of Pharmacy,Children's Hospital Affiliated to Capital Institute of Pediatrics,Beijing 100020,China;Department of Pharmacy,Peking University Third Hospital,Beijing 100191,China;Institute for Drug Evaluation,Peking University Health Science Center,Beijing 100191,China;Department of Pediatrics,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]首都儿科研究所附属儿童医院药学部,北京100020 [2]北京大学第三医院药剂科,北京100191 [3]北京大学医学部药物评价中心,北京100191 [4]北京大学第三医院儿科,北京100191

出　　处：《临床药物治疗杂志》2021年第10期33-39,共7页Clinical Medication Journal

基　　金：十三五国家科技重大专项:儿科常见病示范性新药临床评价技术平台建设(2017ZX09304029-005-02)。

摘　　要：目的总结非静脉途径的H_(1)受体拮抗剂用于治疗儿童变态反应性疾病的推荐意见,并评价指南/共识的质量,为该领域的药物治疗和指南制订提供参考。方法检索PubMed、Embase、万方、中国知网和中国生物医学文献服务系统数据库,检索时限为建库至2020年11月19日,纳入非静脉途径给药的H_(1)受体拮抗剂用于治疗儿童变态反应性疾病的指南/共识。根据不同疾病,定性总结指南/共识中有关H_(1)受体拮抗剂的推荐意见。采用临床指南研究与评估系统Ⅱ(AGREEⅡ)工具,对各纳入指南/共识从范围和目的、参与人员、严谨性、清晰性、应用性、独立性6个维度进行质量评价,并计算ICC值以评估结果一致性。结果共纳入11篇文献,分别来自中国、英国和其他地区或国际组织,制订年限为2000—2019年。AGREEⅡ评价结果提示,仅有范围和目的、清晰性及应用性3个领域平均得分>50%,参与人员、严谨性和独立性的得分普遍较低,整体质量中等。推荐意见方面,各指南/共识均推荐第二代H_(1)受体拮抗剂作为大部分儿童变态反应性疾病的首选药物,部分指南/共识因第一代H_(1)受体拮抗剂的潜在不良反应,不推荐其作为儿童的常规治疗药物。不同指南/共识对同一疾病的升阶梯或联合治疗方案的推荐略有不同,升阶梯或联合方案主要包括鼻用糖皮质激素、白三烯受体拮抗剂、环孢素等。结论目前非静脉途径给药的H_(1)受体拮抗剂用于治疗儿童变态反应性疾病的指南/共识的制订质量中等,第二代H_(1)受体拮抗剂是大多数儿童变态反应性疾病的治疗首选。将来指南的制订应在提升指南质量的同时,进一步考虑儿童用药的特殊性。Objective To summarize the recommendations for the use of non-venous H1-antihistamines for the treatment of allergic diseases in children,and to evaluate the methodological quality of guidelines and consensuses,so as to provide a reference for pharmacotherapy and the development of guidelines.Methods Literatures were systematically retrieved from PubMed,Embase,Wanfang,CNKI and SinoMed from the inception to 19th November,2020.Guidelines or consensuses for the non-venous H1-antihistamine treatments for allergic diseases in children were included.The recommendations from guidelines and consensuses were qualitatively summarized according to the diseases.Each of the included guidelines or consensuses was assessed by using the AGREEⅡinstrument with six quality domains,i.e.,"scope and purpose""stakeholder involvement""rigour of development""clarity of presentation""applicability"and"editorial independence",with calculating ICC values to assess the consistencies.Results A total of 11 literatures were included,which were from China,the United Kingdom,or other regions/international organizations,ranging from 2000 to 2019.The AGREEⅡevaluation results indicated that only three domains("scope and purpose""clarity of presentation""applicability")were averagely scored more than 50%;the scores for"stakeholder involvement""rigour of development"and"editorial independence"were generally much lower.The overall evaluation of included guidelines or consensuses was moderate-quality.All guidelines and consensuses recommended that second generation H1-antihistamines as a first choice for most kinds of pediatric allergic diseases;several guidelines and consensuses recommended against the routine use of first-generation H1 antihistamines in children due to potential adverse reactions.Furthermore,it was suggested that the escalation or combination therapeutic schedules for certain diseases were different,including medications like intranasal corticosteroids,leukotrienes receptor antagonists,ciclosporins,etc.Conclusion The overall quali

关 键 词：儿童 H_(1)受体拮抗剂 变态反应性疾病 指南 AGREEⅡ 

分 类 号：R976[医药卫生—药品]