尘螨特异性免疫治疗对国内尘螨过敏哮喘患儿疗效的Meta分析

Meta-analysis of efficacy of specific immunotherapy for treatment of allergic asthma in Chinese children

目的系统评价特异性免疫治疗(SIT)对国内尘螨过敏哮喘患儿疗效的影响。方法检索2014年10月以前Pub Med、Cochrane Library、Ovid、EBSCOhost、Science Direct、中国生物医学文献服务系统(CBM),中国知网(CNKI)、万方数据库中所有涉及SIT对国内尘螨过敏哮喘患儿疗效的随机对照试验(RCT)或类实验研究,对照组接受GINA推荐的防治方案进行治疗,SIT组在此基础上加上SIT,同时辅以手工检索。严格按照纳入排除标准筛选文献,对符合要求的文献进行质量评价和资料提取,采用Rev Man5.1软件进行Meta分析。结果共纳入12项研究,953例患儿。SIT治疗能显著提高临床治疗有效率(RR=1.14,95%CI:1.08~1.20,P<0.000 01)、日均激素使用量(SMD=-3.43,95%CI:-6.91~0.05,P=0.05)和血清总Ig E(SMD=-0.84,95%CI:-1.19^-0.48,P<0.000 01);治疗1年后哮喘的日间症状(SMD=-0.50,95%CI:-0.99^-0.02,P=0.04)和夜间症状(SMD=-0.86,95%CI:-1.34^-0.38,P=0.0005)均得到改善;第一秒用力肺活量/用力肺活量的比值(FEV1%)在SIT治疗1年后(SMD=0.49,95%CI:-0.20~1.19,P=0.17)和2年后(SMD=3.30,95%CI:-1.95~8.55,P=0.22)差异均无统计学意义;呼气峰流速值(PEF%)在SIT治疗2年后得到显著改善(SMD=1.04,95%CI:0.68~1.41,P<0.000 01)。结论 SIT治疗能显著改善国内尘螨过敏哮喘患儿的临床疗效、日均激素使用量、日间夜间症状、血清总Ig E、PEF%,由于纳入的文献相对较少、质量欠佳,需要高质量的大规模RCT进一步证实。

Objective To systemically analyze the efficacy of specific immunotherapy（SIT） with standardized house dust mite vaccine（Alutard） in Chinese children with allergic asthma. Methods Pub Med, Cochrane Library, Ovid, EBSCOhost, Science Direct, CNKI, CBM and Wanfang Database were searched for the RCTs or CCTs about the efficacy of SIT in Chinese asthmatic children until October 2014. The control group accepted GINA recommended treatment, while the SIT group added SIT into the basic treatment. The relevant journals were also hand-searched. Researchers evaluated papers matched inclusion criteria strictly and extracted data independently. Meta-analysis was conducted using Rev Man 5.1 software. Results A total of 12 RCTs and 953 children with pediatric asthma were included. Meta-analysis results implied that the effective rate was significantly improved among the patients receiving SIT（RR = 1.14, 95%CI：1.08-1.20, P〈0.000 01）, the daily doses of ICS（SMD =-3.43, 95% CI：-6.91-0.05, P = 0.05） and serm total Ig E（SMD =-0.84, 95% CI：-1.19--0.48, P〈0.00001） were decreased in the SIT group. After SIT for 1 year, the day symptoms（SMD =-0.50, 95%CI：-0.99--0.02, P = 0.04） and night symptoms（SMD =-0.86, 95%CI：-1.34--0.38,P = 0.0005） were significantly improved. There was no statistic difference in the FEV1% after SIT for one year（SMD = 0.4 9, 95% CI：-0.20-1.19, P = 0.17） or two years（SMD = 3.30, 95%CI：-1.95-8.55, P = 0.22）. PEF% between the two groups had a significant improvement after SIT for 2 years（SMD = 1.04, 95%CI： 0.68-1.41, P〈0.00001）. Conclusion SIT treatment can significantly improve the clinical effects, average daily hormone usage, daytime symptoms, serum total Ig E, and PEF% of children with allergic asthma in China, but it is limited by lack of enough RCTs with high quality. Large sample of high quality RCTs are necessary to examine the wider applicability of SIT.