地塞米松与泼尼松治疗儿童哮喘急性发作疗效与安全性比较的系统评价

Systematic Review of Dexamethasone and Prednisone in Treatment of Acute Asthma Attacks in Children

目的:系统比较地塞米松与泼尼松治疗儿童哮喘急性发作的疗效与安全性,为临床用药提供依据。方法:计算机检索中国期刊全文数据库、万方数据网、维普数据库,PubMed、Central及EMBase等数据库,检索时限从建库至2018年3月,收集地塞米松(观察组)与泼尼松(对照组)分别治疗儿童哮喘急性发作的对照试验,根据纳入与排除标准筛选文献、提取资料、评价文献质量并交叉核对结果,采用RevMan 5.3软件进行文献荟萃分析(Meta分析)。结果:共纳入8篇文献,涉及1 784例哮喘急性发作患儿。Meta分析结果显示,两组患儿5 d复发率(OR=0.93,95%CI=0.43～1.99,P=0.84)、10～14 d复发率(OR=1.17,95%CI=0.74～1.87,P=0.51)的差异均无统计学意义;观察组患儿呕吐发生率明显低于对照组,差异有统计学意义(OR=0.28,95%CI=0.13～0.59,P=0.001)。结论:地塞米松治疗儿童哮喘急性发作的疗效与泼尼松相当,但呕吐发生率较泼尼松低,安全性好。

OBJECTIVE:To systematically compare the efficacy and safety of dexamethasone and prednisone in treatment of acute asthma attacks in children,so as to provide reference for clinical drug use.METHODS:CNKI,Wanfang database,Vip database,PubMed,Centra land EMBase were retrieved to collect the randomized controlled trial(RCT)of dexamethasone(observation group)and prednisone(control group)in treatment of acute asthma attacks in children from from the date of database establishment to Mar.2018.Two reviewers independently screened literature according to the inclusion and exclusion criteria,extracted information and assessed the methodological quality of included studies.Meta-analysis of the data was performed by using RevMan5.3.RESULTS:Totally8literature were involved,including1784cases of acute asthma attacks.Meta-analysis showed that there was no statistically significant difference between two groups in recurrence rate at5d(OR=0.93,95%CI=0.43-1.99,P=0.84)and10-14d(OR=1.17,95%CI=0.74-1.87,P=0.51).The incidence of vomiting in observation group was significantly lower than that in control group,and the difference was statistically significant(OR=0.28,95%CI=0.13-0.59,P=0.001).CONCLUSIONS:The efficacy of dexamethasone in the treatment of acute asthma attacks in children is comparable to that of prednisone,yet the incidence of vomiting is lower than that of prednisone,and the safety is better.