皮质激素治疗嗜酸性食管炎的疗效及安全性系统评价

Systematic Review of Corticosteroids Treatment for Eosinophilic Esophagitis

目的系统评价皮质激素治疗嗜酸性食管炎的疗效和安全性。方法用计算机检索Medline(1966年1月—2008年1月)、荷兰医学文摘数据库(the excerpta medica database,EMBASE)(1977年1月—2008年1月)、Co-chrane图书馆系统评价资料库(Cochrane database of systematic review,CDSR)(2008年第4期)、Cochrane临床对照试验中心注册数据库(2008年第4期)、中国生物医学文献数据库(CBMdisc)(1978年1月—2008年1月)和中国期刊全文数据库(CNKI)(1979年1月—2008年1月)。以"皮质激素"及"强的松"、"地塞米松"、"氟替卡松"等皮质激素名称作为主题词、自由词,检索皮质激素治疗嗜酸性食管炎的随机对照试验,对符合纳入标准的临床研究进行Meta分析。结果共纳入1篇随机对照研究,Jadad改良法评分>5分,为高质量文献。此研究包括36例嗜酸性食管炎患者,将患者随机分为治疗组(21例)和对照组(15例),分别给予丙酸氟替卡松和安慰剂。发现治疗组治疗后患者组织学缓解率较对照组显著增加,食管远端的食管沟槽数、食管近端及远端食管黏膜嗜酸粒细胞分层现象、食管近端及远端的上皮增生均较对照组显著减少,差异有统计学意义(P<0.05)。治疗组患者呕吐症状较对照组显著改善,差异有统计学意义(67%与27%,P=0.04)。结论现有的临床研究证据显示,与对照组比较,皮质激素治疗嗜酸性食管炎,具有缓解组织学,改善临床症状、内镜下表现及黏膜上皮增生的疗效;且安全性好。

Objective To evaluate systematically the effectiveness and safety of Corticosteroids in eosinophilic esophagitis. Methods We searched Medline （ from 1966 to Jan. 2008 ）, the Netherlands Excerpta Medica database （EMBASE） （from 1977 to Jan. 2008 ）, Cochrane database of systematic review （CDSR） （No 4, 2008 ）, Cochrane Central Register of Controlled Trials data bases （No4, 2008）, Chinese Biomedical Literature Database （CBNdisc） （form 1978 to Jan. 2008） and CNKI （from 1979 to Jan. 2008）. A Meta -analysis was conducted on the randomized controlled trials （RCTs） involving corticosteroids for eosinophilic esophagitis. Results Only 1 RCT was enrolled, which scored 〉 5 by Jadad Scale. The study included 36 eosinophilic esophagitis patients who were divided randomly into groups therapy （n = 21, receiving fluticasone propionate） and control （n = 15, receiving placebo）. It was found that the histological remission rate was significantly higher in therapy group than in control; the distal esophageal groove number, proximal or distal esophageal membrane eosinophil stratification phenomenon and proximal or distal esophageal epithelial hyperplasia reduced significantly in therapy group as compared with control （P 〈0. 05）. The vomiting improved more in therapy group than in control, the difference was significant （67%, 27%, respectively, P = 0. 04）. Conclusion Corticosteroids is an attractive therapy for eosinophilic esophagitis. But this evidence is based on 1 trial, a small sample size. More high - quality trials are needed to clarify the effect of Corticosteroids on eosinophilic esophagitis.