雾化吸入不同给药剂量布地奈德与静脉用甲泼尼龙治疗AECOPD疗效与安全性的Meta分析

The Meta-analysis of the Efficacy and Safety of Different Dosing Doses Budesonide Atomization Inhalation and Methylprednisolone for Injection in the Treatment of Acute Exacerbation of Chronic Obstructive Pulmonary Disease

目的:系统评价雾化吸入不同给药剂量布地奈德与静脉用甲泼尼龙治疗慢性阻塞性肺疾病急性发作(AECOPD)的疗效与安全性。方法:计算机检索中国知网、维普网、万方和PubMed等数据库,并手工检索相关会议论文集和灰色文献等,纳入雾化吸入不同给药剂量布地奈德与静脉用甲泼尼龙治疗AECOPD的随机对照研究。检索时限从各数据库建库至2021年12月31日。按照纳入与排除标准选择文献、质量评价及提取资料后,将不同给药剂量布地奈德分为低剂量组(≤4 mg)和高剂量组(6~8 mg),采用RevMan5.3软件进行Meta分析。结果:共纳入12篇文献,869例患者;其中低剂量组5篇文献、411例患者,高剂量组7篇文献、458例患者。Meta分析结果显示:雾化组与静脉组治疗后动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))和1 s用力呼气量(FEV1)均差异无统计学意义,且亚组分析提示两个剂量组两组治疗后PaO_(2)、PaCO_(2)和FEV1亦差异无统计学意义,进一步敏感性分析提示结果均稳定;雾化组与静脉组治疗后1 s用力呼气量占用力肺活量的百分比[(FEV1/FVC)%]和药品不良反应(ADR)发生率差异有统计学意义,敏感性分析提示结果稳定。结论:雾化吸入不同给药剂量布地奈德治疗AECOPD的疗效与静脉用甲泼尼龙相当,且不良反应发生率较少,结果稳定可靠;其中雾化吸入低剂量布地奈德治疗AECOPD的疗效需要更多循证药学数据进一步验证。

Objective:To assess the efficacy and safety of different dosing doses budesonide atomization inhalation and methylprednisolone for injection in the treatment of acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods:These databases such as CNKI,VIP,Wanfang and Pubmed,were electronically searched,the relevant conference proceedings and grey literature were also hand-searched.Randomized controlled trails of different dosing doses budesonide atomization inhalation and methylprednisolone for injection in the treatment of AECOPD was included.The retrieval period was from the establishment of each database to December 31,2021.The literatures were selected according to the inclusion and exclusion criteria.The included literatures were divided into low-dose group(≤4 mg)and high-dose group(6-8 mg)according to the dose of budesonide.Revman 5.3 software was used for meta-analysis.Results:A total of twelve literatures were included,including 869 patients.The low-dose group included five articles and 411 patients,and the high-dose group included seven articles and 458 patients.Meta-analysis results showed that there were no statistically significant differences in PaO_(2),PaCO_(2)and FEV1 between the atomized group and the intravenous group after treatment,and subgroup analysis showed that there also were no statistically significant differences in PaO_(2),PaCO_(2)and FEV1 between the two groups.Further sensitivity analysis suggested that the results were stable.After treatment,FEV1/FVC(%)and ADR rates were statistically significant differences between the atomized group and the intravenous group,and sensitivity analysis suggested that the results were stable.Conclusion:Based on current clinical data,the efficacy of different dosing doses budesonide atomization inhalation in the treatment of AECOPD is comparable to methylprednisolone for injection,and the incidence of adverse reactions is less,the results are stable and reliable.The efficacy of low-dose budesonide atomization inhalation in the treatment of AECOPD requires more evidence-based pharmaceutical data for further validation.