口服西替利嗪联合布地奈德雾化治疗中国儿童急性哮喘的Meta-分析

Meta-analysis of cetirizine combined with budesonide inhalation for acute asthma in Chinese children

目的系统评价西替利嗪口服联用布地奈德雾化吸入治疗中国患儿急性哮喘的临床疗效和安全性。方法计算机检索PubMed、Cochrane library、万方数据库、中国学术期刊全文数据库(CNKI)、中国生物医学文献数据库(CBM)和维普中文期刊全文数据库(VIP),检索西替利嗪口服联用布地奈德雾化(试验组)对比单用布地奈德雾化吸入(对照组)治疗中国患儿急性哮喘随机对照研究(RCT),检索时限为数据库建库至2020年1月,对符合纳入排除标准的随机对照试验进行数据提取和偏倚风险评价,然后采用RevMan 5.3软件进行Meta-分析。结果共纳入12项RCTs,1215例患者。Meta-分析结果显示:试验组总有效率(RR=1.25,95%CI=1.17~1.33)、痊愈率(RR=1.37,95%CI=1.16~1.63)均高于对照组,日间症状评分(SMD=−1.79,95%CI=−2.65~−0.93)和夜间症状评分(SMD=−1.63,95%CI=−2.42~−0.85)均小于对照组,第1秒用力呼气量(FEV1)增加值(SMD=2.12,95%CI=1.30~2.95)、肿瘤坏死因子-α下降值(SMD=−0.74,95%CI=−0.92~−0.56)大于对照组,差异均具有统计学意义(P<0.01),但两组患儿的不良反应发生率相当(RR=1.42,95%CI=0.89~2.27,P=0.14)。结论西替利嗪口服联用布地奈德雾化吸入治疗中国患儿急性哮喘的疗效确切、提高患儿肺功能、降低炎性因子优于单用布地奈德雾化吸入,且不增加药物不良反应。

Objective To systematically evaluate the effectiveness and safety of cetirizine orally combined with budesonide inhalation for acute asthma in Chinese children.Methods Randomized controlled trial(RCTs)about cetirizine orally combined with budesonide inhalation(Test group)vs budesonide inhalation alone(Control group)for the treatment of acute asthma in Chinese children in databases of PubMed,Cochrane library,CNKI,CBM,VIP and Wanfang Data from inception to January 2020 were searched.Data extraction and bias risk assessment were performed on randomized controlled trials that met the inclusion exclusion criteria.Meta-analysis was performed using RevMan 5.3 software.Results Total of 12 studies involving 1215 patients were entered.Meta analysis showed that:the total effective rate(RR=1.25,95%CI=1.17 to 1.33)and recovery rate(RR=1.37,95%CI=1.16 to 1.63)in the test group were greater than those in the control group,and the daytime symptom score(SMD=−1.79,95%CI=−2.65 to−0.93)and nocturnal symptom score(SMD=−1.63,95%CI=−2.42 to−0.85)are both lower than the control group,increased forced expiratory volume(FEV1)in the first second(SMD=2.12,95%CI=1.30 to 2.95),and decreased value of TNF-α(SMD=−0.74,95%CI=−0.92 to−0.56)is greater than the control group,the differences were statistically significant(P<0.01)and did not increase the incidence of ADR(RR=1.42,95%CI=0.89 to 2.27,P=0.14).Conclusion According to the current evidence,cetirizine orally combined with budesonide inhalation is effective in treating children with acute asthma in China.It improves lung function and reduces inflammatory factors in children.And does not increase the incidence of adverse drug reactions.