吸入性糖皮质激素治疗成年人和青少年哮喘疗效和副作用的Meta-分析

Meta-analysis on the Efficacy and Side effect of Inhaled Corticosteroids for Adult and Adolescent Asthma

目的通过循证医学Meta-分析方法，探讨吸入性糖皮质激素治疗成年人和青少年哮喘的疗效和副作用。方法按照Cochrane系统评价的要求全面检索PUBMED、中国期刊全文数据库等网站并手工检索相关文献，采用RevMan4．2软件，对符合纳入标准的13篇文献共计2356例哮喘患者进行了Meta-分析。结果对清晨PEF、夜晚PEF、FVC、咽部不适率来源文献具有同质性，对FEV．、FEV，％、不利事件发生率、治疗无效率来源文献有异质性。吸入性糖皮质激素治疗组对FEV1、FEV1％、清晨PEF、不利事件发生率、治疗无效率同对照组比较差异有统计学意义；对FVC、夜晚PEF和咽部不适率治疗组和对照组差异无统计学意义。通过敏感性分析显示结果比较稳定。发表偏倚分析显示发表偏倚影响不大，结论比较可靠。结论现有证据表明，吸入性糖皮质激素治疗成年人和青少年哮喘的疗效好、副作用较少，但仍需通过加大样本量及严密的设计，来进一步分析副作用，以期得到更加稳定、可靠的结果。

Objective To assess the efficacy and side effect of inhaled corticosteroids for adult and adolescent asthma. Methods According to the requirements of Cochrane systematic review, a thorough literature search was performed among PUBMED, China National Knowledge Infrastructure, and so on. By RevMan 4. 2 software, a meta analysis was performed on a total of 2356 patients involved in 13 papers which met with the in- clusion criteria. Results The literatures of morning and evening peak expiratory flow（PEF） and forced vital capacity（FVC） and the occurrence of indisposition of pharyngeal portion had homogeneity. The literatures of forced expiratory volume in one second（ FEV1 ）and FEVI percent predicted（ FEV~ % ）and the occurrence of ad- verse events and ineffective of treatment had heterogeneity. Comparing the treatment groups with the control groups, the incorporation of FEV1 ,FEV~ % ,morning PEF and the occurrence of adverse events and ineffective of treatment were statistically significant. While the other three incorporations of FVC and evening PEF and the oc- currence of indisposition of pharyngeal portion were not. Sensitivity analysis showed that the results were stable and reliable. The results of publication bias showed that the impact was small, and the results was reliable. Conclusion The clinical evidences available so far indicated that the treatment of adult and adolescent asthma with inhaled corticosteroids is effective and has less side effect, although rigorous design and large sample size randomized double-blind clinical trials are required to further analysis for more stable and reliable results.