鼻用抗组胺药物治疗变应性鼻炎的Meta分析

Efficacy of intranasal antihistamine in the treatment of allergic rhinitis： a meta-analysis

目的 系统评价鼻用抗组胺药物治疗变应性鼻炎（AR）的临床疗效,为优化AR药物治疗提供循证参考.方法 计算机检索OVID、PubMed、EMBASE和Cochrane Librar、中国学术期刊全文数据库、万方数据库,检索时间为1985年1月至2014年1月,纳入有关鼻用抗组胺药物治疗AR的随机对照研究,经2位研究者独立进行文献筛选、资料提取和方法学质量评价后,采用RevMan 5.1软件进行Meta分析.结果 经检索和筛选,共纳入13个随机对照试验进行研究.Meta分析结果显示：鼻用抗组胺药物组的鼻部症状总分及鼻塞、流涕、喷嚏各项症状评分较安慰剂组降低,差异有统计学意义[加权均数差（WMD）=-1.96,95％可信区间（CI）为-2.06～-1.85;WMD=-0.18,95％ CI为-0.28～-0.08;WMD=-0.45,95％ CI为-0.52～-0.38;WMD=-0.41,95％ CI为-0.58～-0.24;P值均＜0.01].鼻用抗组胺药物组的鼻部症状总分与鼻用糖皮质激素组差异无统计学意义（WMD=-1.51,95％ CI为-3.51～0.49,P=0.14）;而鼻用抗组胺药组的鼻塞、流涕、喷嚏评分较鼻用糖皮质激素组降低,差异有统计学意义（WMD=-0.23,95％ CI为-0.40 ～-0.06;WMD=-0.35,95％ CI为-0.65～-0.05;WMD=-0.25,95％ CI为-0.42～-0.08,P值均＜0.05）.与口服抗组胺药组相比,鼻用抗组胺药组的鼻部症状总评分降低,差异有统计学意义（WMD=-0.88,95％ CI为-1.51～-0.25,P＜0.01）.结论 鼻用抗组胺药物能有效改善AR患者的鼻部症状.

Objective To systematically evaluate the efficacy of intranasal antihistamine in the treatment of allergic rhinitis.Methods The randomized controlled trials （RCT） about intranasal antihistamines for the treatment of allergic rhinitis between January 1985 and January 2014 were searched in OVID,PubMed,EMBASE,CNKI,WanFang Data and Cochrane Library.Two reviewers independently screened the literatures,extracted the data,and evaluated the methodological quality,then meta-analysis was performed by using RevMan 5.1 software.Results A total of thirteen RCTs were included.The results of meta-analysis showed that the efficacy of intranasal antihistamine group was superior to the placebo group in total nasal symptom scores （TNSS）,the difference was significant [WMD =-1.96,95% CI （-2.06; -1.85）,P 〈 0.01],and individual nasal symptom scores （blocked nose,rhinorrhea,and sneezing）[WMD=-0.18,95%CI （-0.28;-0.08）; WMD=-0.45,95%CI （-0.52;-0.38） ;WMD=-0.41,95% CI （-0.58 ;-0.24）,all P 〈 0.01],with significant differences.There was no significant difference between the intranasal antihistamine group and the corticosteroid group in TNSS [WMD =-1.51,95% CI （-3.51; 0.49）,P =0.14],but the intranasal antihistamines group was superior to the corticosteroid group in individual nasal symptom scores （blocked nose,rhinorrhea,and sneezing） [WMD =-0.23,95% CI （-0.40;-0.06） ; WMD =-0.35,95% CI （-0.65 ;-0.05） ; WMD =-0.25,95% CI （-0.42;-0.08）,all P 〈 0.05],with significant differences.The intranasal antihistamine group was superior to the oral antihistamines group in TNSS [WMD =-0.88,95% CI （-1.51 ;-0.25）,P 〈 0.01].Conclusion Intranasal antihistamine is effective in the control of nasal symptoms in AR patients.