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目的 比较使用抗白三烯药物和吸入型糖皮质激素单独治疗哮喘患者的安全性和疗效。 设计 对使用抗白三烯药物和吸入型糖皮质激素治疗儿童和成人哮喘达28天或以上的随机对照试验进行系统性综述。 主要评价指标 因症状急性加重而必须使用全身糖皮质激素的次数。 结果 共有13个临床试验(12个为成人试验,1个为儿童试验)满足入选标准;所有病例均为轻度和中度哮喘患者。白三烯受体拮抗剂与每日等效于二丙酸倍氯米松(Beclometasone dipropionate)400～450μg剂量的吸入型糖皮质激素进行比较。白三烯受体拮抗剂治疗的患者有60％更容易出现急性加重而需使用全身糖皮质激素(相对危险度1.6,95％的可信区间1.2—2.2;需要处理的患者数量为27,13～81)。与白三烯受体拮抗剂治疗组比较,在吸入型糖皮质激素组,1秒用力肺活量多增加130ml(80ml～170m1),晨间峰值呼气流速也多增加19升/分钟(14升/分钟到24升/分钟),而且夜间憋醒需应急使用B2激动剂的次数和无症状天数指标也表明吸入型糖皮质激素疗效更好。两组治疗发生副作用的危险没有差别,但是,白三烯受体拮抗剂组可因为哮喘控制不佳而使戒断的危险性增加2.5倍(相对危险度2.5,1.8～3.5)。 结论治疗成人轻度或中度哮喘患者,等效于400μg/日二丙酸倍氯米松剂量的吸入型糖皮质激
Objective To compare the safety and efficacy of anti-leukotriene drugs and inhaled corticosteroids alone in the treatment of asthma. A systematic review of randomized controlled trials of anti-leukotriene drugs and inhaled corticosteroids in children and adults with asthma for 28 days or more was designed. The main evaluation index due to acute exacerbations and the need to use systemic glucocorticoid frequency. Results A total of 13 clinical trials (12 for adults and 1 for children) met the inclusion criteria; all were mild and moderate asthma. Leukotriene receptor antagonists were compared with inhaled glucocorticoids daily at doses equivalent to 400-450 μg of Beclometasone dipropionate. Sixty percent of patients treated with leukotriene receptor antagonists were more likely to develop acute exacerbations requiring systemic glucocorticosteroids (relative risk 1.6, 95% confidence interval 1.2-2.2; patients requiring treatment of 27,13 ~ 81). Compared with the leukotriene receptor antagonist group, in the inhaled glucocorticoid group, forced expiratory volume increased by 130ml (80ml ~ 170ml) in 1 second, morning peak expiratory flow rate increased by 19μl / minute (14l / Minute to 24 liters / minute), and the number of B2 agonists to be used urgently at night and indicators of asymptomatic days also indicate that inhaled corticosteroids are more effective. There was no difference between the two groups in the risk of side effects, however, leukotriene receptor blockers increased the risk of withdrawal by 2.5-fold due to poor asthma control (relative risk 2.5, 1.8-3.5). Conclusions In patients with mild or moderate asthma, equivalent doses of 400 μg / day of beclomethasone dipropionate were inhaled cortisol