支气管热成形术治疗难治性哮喘的疗效与安全性的Meta分析

Efficacy and Safety of Bronchial Thermoplasty for Patients with Refractory Asthma:a Meta Analysis

背景支气管热成形术(BT)是在常规治疗基础上辅助治疗难治性哮喘的全新非药物性治疗方法,能降低平滑肌支气管收缩力,缓解哮喘症状和恶化,从而改善哮喘控制和生活质量。目的系统评价BT治疗难治性哮喘的疗效和安全性。方法计算机检索PubMed、EMBase、ClinicalTrials.gov、中国知网、万方数据知识服务平台、维普中文数据库,检索时间为建库至2017年2月,收集BT治疗难治性哮喘的随机对照试验(RCT),同时手工检索相关研究的参考文献,对纳入文献进行质量评价和数据提取,采用RevMan 5.3软件进行分析。结果共纳入5项研究。Meta分析结果显示,BT治疗后1年与5年患者第1秒用力呼气末容积占预计值百分比(FEV1%)比较,差异无统计学意义[WMD=-0.75,95%CI(-3.36,1.85),P=0.57];BT组呼气流量峰值(PEF)高于对照组[WMD=23.98,95%CI(15.12,32.83),P<0.000 01];BT组哮喘生命质量问卷(AQLQ)评分高于对照组[WMD=0.52,95%CI(0.25,0.78),P=0.000 2];BT组哮喘控制问卷(ACQ)评分高于对照组[WMD=-0.52,95%CI(-0.84,-0.20),P=0.002];两组急救药物使用次数比较,差异无统计学意义[WMD=-0.28,95%CI(-3.42,2.85),P=0.86];BT组无症状时间长于对照组[WMD=23.63,95%CI(14.92,32.33),P<0.000 1];BT组治疗后1年呼吸道不良反应住院率低于对照组,差异有统计学意义[OR=3.16,95%CI(1.12,8.93),P=0.03];BT治疗后1年与5年患者呼吸道不良反应住院率比较,差异无统计学意义[OR=1.51,95%CI(0.68,3.38),P=0.31]。结论 BT治疗难治性哮喘可明显改善患者肺功能、症状和生活质量,且安全有效。

Background Bronchial thermoplasty(BT)is a new non-drug treatment for refractory asthma on the basis of conventional therapy.It can reduce the contraction of airway smooth muscle,alleviate asthma symptoms and deterioration,and improve asthma control and quality of life.Objective To evaluate the efficacy and safety of BT in the treatment of refractory asthma(RA)by using a systematic review.Methods We searched PubMed,EMBase,ClinicalTrials.gov,CNKI,Wanfang Data Knowledge Service Platform and VIP for randomized controlled trials(RCT)published as of February 2017,in which the efficacy and safety of BT in the treatment of RA were reported,and reviewed the studies listed as references of the relevant RCT published in printed journals.Data were extracted from eligible RCT and quality assessment was conducted with Revman 5.3.Results Five RCT were included.Meta-analysis showed that the FEV1%predicted was similar between RA patients with 1-year BT treatment and those with 5-year BT treatment〔WMD=-0.75,95%CI(-3.36,1.85),P=0.57〕;compared with the controls,BT-treated patients showed significantly improved peak expiratory flow(PEF)〔WMD=23.98,95%CI(15.12,32.83),P<0.000 01〕,much enhanced Asthma Quality of Life Questionnaire(AQLQ)score〔WMD=0.52,95%CI(0.25,0.78),P=0.000 2〕,obviously increased Asthma Control Questionnaire(ACQ)score〔WMD=-0.52,95%CI(-0.84,-0.20),P=0.002〕,notably longer asymptomatic duration〔WMD=23.63,95%CI(14.92,32.33),P<0.000 1〕and apparently lower rate of hospitalization due to respiratory adverse events during a 1-year treatment perio〔d OR=3.16,95%CI(1.12,8.93),P=0.03〕.However,both groups showed no significant differences in the frequency of receiving emergency drug therapy〔WMD=-0.28,95%CI(-3.42,2.85),P=0.86〕.There was no significant difference in hospitalization rate of adverse respiratory reactions between 1 year and 5 years after BT treatment〔OR=1.51,95%CI(0.68,3.38),P=0.31〕.Conclusion BT can significantly improve the pulmonary function,asthma symptoms and quality of life of RA patients with good safety.