神经氨酸酶抑制剂治疗儿童流行性感冒有效性和安全性的系统评价

Efficacy and safety of neuraminidase inhibitors treating influenza in children： a systematic review

目的 系统评价神经氨酸酶抑制剂（NAI）治疗儿童流行性感冒（流感）的有效性和安全性。 方法 计算机检索PubMed、Cochrane library、Embase、中国期刊全文 数据库、维普中文科技期刊数据库和万方数据库，选取关于NAI治疗儿童流感的随机对照试验。将研究对象分为试验组和对照组，试验组使用NAI治疗儿童流感，对照组使用安慰剂 。按照纳入与排除标准进行文献筛选、提取资料，并对研究的方法学进行评价后，采用Revman 5.3软件进行Meta分析。 结果 试验组流感症状的缓解时间短于对照组，辅助药 物使用剂量少于对照组，差异有统计学意义（均P＜0.05）。Meta分析结果显示，试验组抗菌药物使用率及中耳炎发生率低于对照组，差异均有统计学意义（相对危险度=0.65，95% 置信区间：0.48～0.88，P=0.006；相对危险度=0.59，95%置信区间：0.41～0.86，P=0.006）；但在不良反应方面，除呕吐发生率较对照组更高外（比值比=1.66，95%置信区间： 1.25～2.21，P=0.000 5），试验组恶心、腹泻发生率与对照组比较，差异均无统计学意义（比值比=0.41，95%置信区间：0.14～1.17，P=0.10；比值比=0.88，95%置信区间：0.66～ 1.18，P=0.39）。 结论 使用NAI治疗儿童流感的有效性和安全性良好，但受纳入研究的数量和质量限制，本研究结论尚需要开展更多高质量研究加以验证。

Objective To review the efficacy and safety of neuraminidase inhibitors（NAI） in the treatment of influenza in children. Methods Randomized controlled trials on NAI treating influenza in children were searched in databases including PubMed, Embase, Cochrane Library, CNKI, VIP and WanFang Data; the experimental group was treated with NAI and the control group was treated placebo. Clinical data were abstracted and the methodology of research was evaluated. Meta-analysis was conducted using RevMan 5.3 software. Results The remission time of influenza symptom in experimental group was shorter than that in control group, the adjunctive drug dose in experimental group was less than that in control group, the differences were statistically significant（P〈0.05）. The application rate of antibiotic agents and the incidence of otitis media in experimental group was significantly lower than that in control group（relative risk=0.65, 95% confidence interval： 0.48-0.88, P=0.006; relative risk=0.59, 95% confidence interval： 0.41-0.86, P=0.006）. The incidence of vomit in experimental group was significantly higher than that in control group（odds ratio=1.66, 95% confidence interval： 1.25-2.21, P=0.000 5）. Incidences of nausea and diarrhea had no significant differences between groups（odds ratio=0.41, 95% confidence interval： 0.14-1.17, P=0.10; odds ratio=0.88, 95% confidence interval： 0.66-1.18, P=0.39）. Conclusions NAI treating influenza in children is safe and effective.