舌下免疫治疗变应性支气管哮喘疗效与安全性的Meta分析

A Meta-analysis of efficacy and safety of sublingual immunotherapy on allergic asthma

目的 评价舌下免疫治疗（SLIT）变应性支气管哮喘（以下简称哮喘）的疗效与安全性,为SLIT的临床应用提供可靠的循证医学证据.方法 检索中国知网、万方数据库、Pubmed、Medline国内外公开发表的SLIT变应性哮喘的随机对照试验（RCT）；采用Jadad评分法评估各项研究的质量；Meta分析用Stata 11.0软件完成；采用固定或随机效应模型分析研究结果；无法进行合并的效应量采用描述性分析；采用Egger＇s和Begg＇s检验评价发表偏倚.结果 纳入6项RCT研究,Meta分析结果显示,与对照组比,SLIT组哮喘症状评分显著降低[标准化均数差（SMD）=-0.89,95％ CI-1.36～-0.43,P=0.000],哮喘药物使用评分降低（SMD=-4.53,95％CI-6.97～-2.08,P=0.000）；第1秒用力呼气容积（FEV1）（SMD =0.19,95％ CI-0.02～0.41,P=0.078）和血清变应原特异性IgE水平（SMD=0.05,95％ CI-0.58 ～0.69,P=0.870）差异无统计学意义（P＞0.05）；SLIT无明显不良反应；Egger＇s和Begg＇s检验结果显示无发表偏倚.结论 SLIT可以明显降低变应性哮喘症状评分、药物使用评分,是一种安全有效的免疫途径；但需要开展更高质量的RCT研究,为SLIT的广泛应用提供更加有力的证据.

Objective To evaluate the efficacy and safety of sublingual immunotherapy （SLIT） in patients with allergic asthma in order to provide reliable evidence for clinical application of SLIT. Methods To search published articles of randomized controlled trials （RCTs） in allergic asthma from CNKI, WANFANG, Pubmed and Medline databases. The methodological quality of trials was assessed by Jadad- scale. The heterogeneity was examined by using Stata 11.0 software. Fixed effect model or random effect model was used to pool the data. The articles which could not be pooled were carried out by descriptive analysis. The Egger＇s and Begg＇s test were used to evaluate the publication bias. Results There were total 6 RCTs included in this text. Compared with control group, SLIT could significantly reduce asthma symptom scores （SMD= -0.89, 95%C1 -1.36--0.43, P=0.000） and asthma medication scores （SMD = - 4. 53, 95% C1 - 6. 97- - 2. 08, P = 0. 000） , but not forced expiratm7 volume （ FEVI ） of lung function （SMD=0.19, 95%C1 -0.02-0.41, P=0.078）, neither serum slgE levels （SMD =0.05, 95%C1 -0. 58-0. 69, P = 0. 870）. There were no obvious adverse events reported after treatment of SLIT. No publication bias were indicated by Egger＇s and Begg＇s tests. Conclusion SLIT significantly reduces asthnm symptom scores and medication scores, suggesting that SLIT is a safe and effective approach of immunotherapy. However, it still needs more highly qualified studies of RCTs to prove.