指南推荐的药物治疗方案对5~18岁中重度哮喘患者哮喘症状评分影响的网状Meta分析  

Effects of guide-recommended treatment strategies on asthma symptom scores in moderate-to-severe asthma patients aged 5-18 years:a network meta-analysis

作　　者：李建荣 刘凤琪 刘佐相 彭和香 曾雪扬 陈亚红[2] 吴涛[1,3] 孙凤[1,3,4] LI Jianrong;LIU Fengqi;LIU Zuoxiang;PENG Hexiang;ZENG Xueyang;CHEN Yahong;WU Tao;SUN Feng(Department of Epidemiology and Health Statistics,School of Public Health,Peking University,Beijing 100191,P.R.China;Department of Respiratory Medicine,Peking University Third Hospital,Beijing 100191,P.R.China;Key Laboratory of Epidemiology of Major Diseases(Peking University),Ministry of Education,Beijing 100191,P.R.China;Peking University Center for Evidence Based Medicine and Clinical Research,Beijing 100191,P.R.China)

机构地区：[1]北京大学公共卫生学院流行病与卫生统计学系,北京100191 [2]北京大学第三医院呼吸内科,北京100191 [3]重大疾病流行病学教育部重点实验室(北京大学),北京100191 [4]北京大学循证医学中心,北京100191

出　　处：《中国循证医学杂志》2024年第9期1044-1051,共8页Chinese Journal of Evidence-based Medicine

基　　金：中国中医药循证医学中心业务研究室主任专项(编号:2020YJSZX-2)。

摘　　要：目的采用网状Meta分析的方法评价全球哮喘倡议委员会推荐的药物治疗方案在5~18岁中重度哮喘患者中的疗效。方法计算机检索PubMed、Embase、Cochrane Library、CNKI、WanFang Data、VIP、SinoMed、临床研究注册平台(ClinicalTrials.gov),搜集关于5~18岁哮喘患者且报告了哮喘症状评分的随机对照试验(RCT),检索时限均为建库至2023年8月26日。由2位研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用Stata 15.0软件进行网状Meta分析。结果最终纳入23个研究,其中23篇RCT报告了日间哮喘症状评分,与低剂量ICS组症状评分相比,低剂量ICS+LABA+LTRA[SMD=-1.4,95%CI(-1.99,-0.81)]和低剂量ICS+LABA+SABA[SMD=-1.43,95%CI(-2.48,-0.39)]在改善日间症状方面有统计学差异。20篇RCT报告了夜间哮喘症状评分,与低剂量ICS组症状评分相比,低剂量ICS+LABA+LTRA[SMD=-1.20,95%CI(-2.20,-0.21)]差异有统计学意义。进行疗效排序后显示,日间、夜间哮喘症状评分排第一位的均为低剂量ICS+LABA+LTRA组。结论低剂量ICS+LABA+LTRA在改善日间、夜间哮喘症状评分方面疗效最优。Objectives To evaluate the improvement of symptoms in patients with moderate to severe asthma aged 5-18 years treated with GINA(Global Initiative for Asthma)guidelines by network meta-analysis.Methods Randomized controlled trials(RCTs)about asthma patients aged 5 to 18 years with reported asthma symptom scores were collected from PubMed,Embase,Cochrane Library,CNKI,WanFang Data,VIP,SinoMed and clinical trial registry platform(ClinicalTrials.gov).The search time limit was from the inception to August 26,2023.After two researchers independently screened literature,extracted data and evaluated the risk of bias of included studies,Stata 15.0 software was used for network meta-analysis.Results A total of 23 studies were included,23 of which reported daytime asthma symptom scores.Compared with symptom scores in the low-dose ICS group,there was a statistically significant difference in improvement of daytime symptoms between low-dose ICS+LABA+LTRA(SMD=−1.4,95%CI−1.99 to−0.81)and low-dose ICS+LABA+SABA(SMD=−1.43,95%CI−2.48 to−0.39).Symptom scores for nighttime asthma were reported in 20 RCTs,and there was a statistically significant difference in symptom scores for low-dose ICS+LABA+LTRA(SMD=−1.20,95%CI−2.20 to−0.21)compared with the low-dose ICS group.After the ranking of efficacy,the number one asthma symptom score in both daytime and nighttime was low-dose ICS+LABA+LTRA group.Conclusion Low dose ICS+LABA+LTRA has the best efficacy in improving daytime and nighttime asthma symptom scores.

关 键 词：哮喘 青少年儿童 哮喘症状评分 网状Meta分析 

分 类 号：R725.6[医药卫生—儿科] R562.25[医药卫生—临床医学]