吸入丙酸氟替卡松对支气管哮喘患者肾上腺功能影响的meta分析

Inhaled fluticasone propionate and adrenal effects in adult bronchial asthma： a meta-analysis

目的根据现有临床研究评价吸入丙酸氟替卡松（FP）对支气管哮喘（简称哮喘）患者肾上腺功能影响的剂量-效应关系。方法从1978—2007年MEDLINE光盘数据库和1978—2007年中国生物医学光盘数据库，检索哮喘患者吸入FP为研究对象、比较吸入FP4周后，进行促肾上腺皮质素刺激实验的随机对照实验文献，对肾上腺功能影响的剂量-效应关系进行随机、安慰剂对照的meta分析。结果有5项研究中的732例哮喘患者符合纳入标准，安慰剂组肾上腺功能低于正常值例数是3．9％；FP组增加至500μg／d的剂量，肾上腺功能异常增加的比数比是1．38（95％的可信限为1．01～1．59）；当FP逐渐增加至2000μg／d，与肾上腺功能异常呈线性关系。结论常规应用FP200-500μg／d是安全的，对肾上腺功能的影响很小。

Objective To pool the data of studies about the dose-response relationship of inhaled flutieasone propionate（FP） for adrenal suppression in adults with bronchial asthma（asthma）. Methods The meta-analysis of placebo-controlled randomised dose-response studies of ≥4 weeks＇ duration were chosen from MEDLINE disks from 1978 to 2007 and CBM disks from 1978 to 2007, which assessed the adrenal effects of FP by cosyntropin stimulation tests in adult asthma. Results Five studies, with a total of 732 subjects with asthma,met the inclusion criteria. The proportion of subjects with adrenal function below the lower limit of the normal range on placebo was 3.9% .for increase up to 500μg per day in FP dose,the odds of an abnormality increased by 1.38 （950/00 confidence interval 1.01-1.59）. The outcome measures showed an inverse linear relationship with the FP dose up to 2 000 μg per day. Conclusions For routine prescribing within the established therapeutic dose-response range （200-500 μg per day）, FP has minimal effects on adrenal function.