布地奈德与福莫特罗同时用于哮喘控制和缓解治疗的Meta分析

Simultaneous use of budesonide and formoterol in asthma control and relieving therapy:a Meta analysis

目的系统评估布地奈德(BUD)与福莫特罗(FORM)同时用于哮喘控制和缓解治疗的有效性及安全性。方法通过检索PubMed、Cochrane Library、EMbase、维普(VIP)、中国知网(CNKI)、中国生物医学文献(CBM)、万方数据知识服务平台数据库,收集各数据库建库至2017年5月关于BUD与FORM同时用于哮喘控制和缓解治疗(观察组),BUD与FORM用于哮喘控制、特布他林(TER)用于缓解治疗(对照组)的随机对照试验(RCT)。采用RevMan 5.3进行Meta分析。结果共纳入5个研究(6个对照组)10 158例患者。观察组在哮喘加重入院或急诊人次(OR=0.70,95%CI:0.59~0.85,P<0.01)、严重不良事件发生率(OR=0.66,95%CI:0.52~0.82,P<0.01)及各种原因致试验终止发生率(OR=0.84,95%CI:0.73~0.96,P=0.01)低于对照组;与观察组比较,对照组治疗后夜间最大呼气峰流速(PEF)值及第1秒用力呼气量(FEV1)改善更明显(MD=6.04,95%CI:3.64~8.43,P<0.01;MD=0.04,95%CI:0.03~0.05,P<0.01);两组患者治疗前后夜间觉醒减少次数及致死性不良事件发生率比较,差异无统计学意义(OR=1.25,95%CI:1.00~1.56,P=0.05;OR=1.01,95%CI:0.23~4.45,P=0.99)。结论BUD与FORM同时用于哮喘控制和缓解治疗,在减少哮喘急性发作及安全性方面有优势;BUD与FORM用于哮喘控制、TER用于缓解治疗,在改善肺功能方面效果更佳。

Objective To systematically assess the effectiveness and safety of simultaneously using budesonide（BUD）and formoterol（FORM）in asthma control and relieving therapy.Methods The databases including PubMed,Cochrane Library,EMbase,VIP,CNKI,CBM,Wanfang Data Knowledge Service Platform Database were retrieved by computer.The randomized controlled trials（RCTs）about BUD and FORM simultaneous use in asthma control and relieving therapy（observation group）,BUD and FORM use in asthma control and terbutaline（TER）use in relieving therapy were collected in the various databases from their establishment to May 2017.The meta analysis was conducted by adopting the RevMan 5.3 software.Results A total of 5 RCTs（6 control groups）involving 10158 patients were included.The observation group was lower than the control group in the aspects of asthma aggravation admission or emergency person-times（OR=0.70,95%CI：0.59-0.85,P〈0.01）,occurrence rate of serious adverse events（OR=0.66,95%CI：0.52-0.82,P〈0.01）,occurrence rate of experiment termination by various causes[OR=0.84,95%CI：0.73-0.96,P=0.01）;compared with the observation group,the improvement of night PEF value and FEV1 value after treatment in the control group was more significant（MD=4.05,95%CI：0.18-7.93,P=0.04;MD=0.04,95%CI：0.03-0.05,P〈0.01）;the number of nocturnal awakening decrease times and occurrence rate of fatal adverse events had no statistically significant difference between the two groups[OR=1.25,95%CI：1.00-1.56,P=0.05;OR=1.01,95%CI：0.23-4.45,P=0.99）.Conclusion BUD and FORM simultaneous use in asthma control and relieving therapy has an advantage in the aspects of reducing asthma acute attack and safety;BUD and FORM is used in asthma control,while TER is used in relieving therapy and has better effect for improving the lung function.