超细颗粒丙酸倍氯米松对哮喘患者小气道异常疗效的Meta分析  

Meta-Analysis of Ultrafine Beclomethasone Dipropionate Granules in the Treatment of Small Airway Abnormalities in Children with Asthma

作　　者：谢建芳 朱琳[1] 刘莎[1] 刘芳君[1] 田代印[1] Xie Jianfang;Zhu Lin;Liu Sha;Liu Fangjun;Tian Dianyin(Children’s Hospital of Chongqing Medical University,Ministry of Education Key Laboratory of Child Development and Disorders,National Clinical Research Center for Child Health and Disorders,China International Science and Technology Cooperation Base of Child Development and Critical Disorders,Chongqing Key Laboratory of Pediatrics,Chongqing 400014,China)

机构地区：[1]重庆医科大学附属儿童医院,儿童发育疾病研究教育部重点实验室,国家儿童健康与疾病临床医学研究中心,儿童发育重大疾病国家国际科技合作基地,儿科学重庆市重点实验室,重庆400014

出　　处：《儿科药学杂志》2023年第9期19-25,共7页Journal of Pediatric Pharmacy

摘　　要：目的:系统评价超细颗粒倍氯米松(BDP)与普通吸入性糖皮质激素(ICS)对哮喘患者小气道异常的疗效,为小气道功能障碍哮喘患者的治疗提供参考。方法:计算机检索the Cochrane Library、PubMed、EMBase、Clinical Trials.gov、中国知网、万方数据库、中国生物医学文献数据库(CBM)、维普数据库,收集关于超细颗粒BDP与普通ICS对哮喘患者小气道影响的随机对照试验(RCT),检索时限均为建库至2021年11月。两位研究人员独立筛选文献、提取资料及评估方法学质量后,采用Cochrane风险偏倚评估工具,RevMan 5.4软件进行Meta分析。结果:最终纳入12篇RCT。超细颗粒BDP与普通ICS在改善最大呼气中段流速(MMEF,SMD=0.55,95%CI 0.08~1.03,P<0.05)、闭合容量(CC,MD=-0.33,95%CI-0.39~-0.27,P<0.01)、小气道阻力(MD=-0.03,95%CI-0.05~-0.01,P<0.01)方面比较差异均有统计学意义。超细颗粒BDP与普通ICS在剩余50%肺活量时的用力呼气流量(MEF_(50),MD=2.36,95%CI-5.09~9.80,P>0.05)、剩余25%肺活量时的用力呼气流量(MEF_(25),MD=4.81,95%CI-1.60~11.22,P>0.05)、残气量(RV,SMD=-0.21,95%CI-0.81~-0.38,P>0.05)、残气量/肺总量(RV/TLC,SMD=-0.36,95%CI-1.06~0.33,P>0.05)、闭合容量(CV,SMD=-1.14,95%CI-3.23~0.94,P>0.05)、肺泡一氧化氮(CaNO,MD=-0.35,95%CI-1.29~0.60,P>0.05)方面比较差异均无统计学意义。结论:超细颗粒BDP与普通ICS治疗哮喘患者小气道异常比较,在改善MMEF、CC和小气道阻力上具有优势。受样本量及小气道参数不同的影响,此结论尚需更多高质量研究进一步验证。Objective:To systematically review the efficacy of ultrafine beclomethasone dipropionate(BDP)granules and general inhaled glucocorticoids(ICS)in the treatment of small airway abnormalities in children with asthma,so as to provide reference for the treatment of small airway dysfunction in children with asthma.Methods:The Cochrane Library,PubMed,EMBase,Clinical Trials gov,CNKI,Wanfang,CBM,VIP databases were retrieved from the establishment of the databases to Nov.2021.Randomized controlled trials(RCT)with effects of ultrafine BDP granules and general ICS on small airway in patients with asthma were collected.Two researchers independently screened literature,extracted data,and assessed the methodological quality,Meta-analysis was performed by using Cochrane risk bias assessment and Revman 5.4 software.Results:Totally 12 RCT were included.There were statistically significant differences between ultrafine BDP granules and general ICS in improving maximal mid-expiratory flow(MMEF,SMD=0.55,95%CI 0.08 to 1.03,P<0.05),closing capacity(CC,MD=-0.33,95%CI-0.39 to-0.27,P<0.01)and small airway resistance(MD=-0.03,95%CI-0.05 to-0.01,P<0.01).There were no statistically significant differences between ultrafine BDP granules and general ICS in forced expiratory flow at 50%of forced vital capacity(MEF50,MD=2.36,95%CI-5.09 to 9.80,P>0.05),forced expiratory flow at 25%of forced vital capacity(MEF25,MD=4.81,95%CI-1.60 to 11.22,P>0.05),residual volume(RV,SMD=-0.21,95%CI-0.81 to-0.38,P>0.05),residual volume to total lung capacity ratio(RV/TLC,SMD=-0.36,95%CI-1.06 to 0.33,P>0.05),closing volume(CV,SMD=-1.14,95%CI-3.23 to 0.94,P>0.05)and alveolar nitric oxide(CaNO,MD=-0.35,95%CI-1.29 to 0.60,P>0.05).Conclusion:Ultrafine BDP has more advantages over general ICS in improving MMEF,CC and small airway resistance.However,due to the influence of variations in sample size and small airway parameters among the included studies,the conclusion still requires further validation through more high-quality research.

关 键 词：哮喘 小气道 超细颗粒 倍氯米松 系统评价 META分析 

分 类 号：R725.6[医药卫生—儿科]