大剂量布地奈德对慢性阻塞性肺疾病急性加重期疗效和安全性的Meta-分析

Efficacy and safety of high-dose budesonide on acute exacerbation of chronic obstructive pulmonary disease: A Meta-analysis

目的系统评价大剂量布地奈德治疗慢性阻塞性肺病急性加重期(AECOPD)的疗效和安全性,为临床合理用药提供参考。方法检索Cochrane Library、PubMed、Embase、万方数据库、中国学术期刊全文数据库(CNKI)和中国生物医学文献数据库(CBM)等专业数据库,收集大剂量布地奈德(试验组)对比常规剂量布地奈德(对照组)治疗AECOPD的随机对照试验(RCT),时间从建库到2019年5月。提取相关资料并评价文献质量,使用RevMan 5.3软件进行Meta-分析。结果共纳入12项RCTs,878例患者。Meta-分析结果显示,试验组患者在改善临床症状评分[MD=-1.00,95%CI(-1.44,-0.56),P<0.01]、升高动脉血氧分压(PaO2)[MD=5.71,95%CI(5.03,6.38),P<0.01]、降低动脉血二氧化碳分压(PaCO2)[MD=-5.75,95%CI(-7.24,-4.26),P<0.01]、升高1 s用力呼气量(FEV1)[MD=0.20,95%CI(0.10,0.30),P<0.01]及FEV1占用力肺活量(FVC)的百分比(FEV1/FVC)[MD=5.69,95%CI(1.46,9.91),P<0.01]均显著优于对照组。但试验组患者口腔真菌发生率[RR=3.18,95%CI(1.18,8.55),P=0.02]也显著大于对照组。结论大剂量布地奈德治疗AECOPD与常规剂量相比,临床疗效更优,但增加口腔真菌感染的风险。

Objective To systematically evaluate the efficacy and safety of high-dose budesonide on acute exacerbation of chronic obstructive pulmonary disease(AECOPD),and to provide a reference for the rational drug use.Methods Retrieved from the Cochrane Library,PubMed,Embase,Wanfang,CNKI and CMB database from the inception to May 2019,randomized controlled trials(RCTs)about of high-dose budesonide(test group)compared with conventional-dose budesonide(control group)in the treatment of AECOPD was collected.After the data extraction and evaluation quality of RCTs,Meta-analysis was conducted by using RevMan 5.3 software.Results A total of 12 RCTs were included,involving 878 patients.Meta-analysis showed that improving clinical symptom scores[MD=-1.00,95%CI(-1.44,-0.56),P<0.01],elevated PaO2[MD=5.71,95%CI(5.03,6.38),P<0.01],lower PaCO2[MD=-5.75,95%CI(-7.24,-4.26),P<0.01],increase FEV1[MD=0.20,95%CI(0.10,0.30),P<0.01]and FEV1/FVC(%)[MD=5.69,95%CI(1.46,9.91),P<0.01]of test group were significantly better than that of the control group.But oral fungal infections rate of test group[RR=3.18,95%CI(1.18,8.55),P=0.02]were significantly higher than that of the control group.Conclusion High-dose budesonide has better clinical efficacy compared with conventional-dose of budesonide in the treatment of AECOPD.But increase the risk of oral fungal infections.