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目的系统比较按需间断吸入糖皮质激素和每日规律吸入糖皮质激素两种治疗策略对于哮喘患儿的安全性和有效性。方法通过检索PubMed、Cochrane Library、clinicaltrials.gov以及中国生物医学文献数据库,收集1980年至2013年10月已公开发表的相关文献进行荟萃分析。结果根据关键词检索,共搜索到943篇文献,最终有4篇(5个对比组)平行设计、前瞻性、随机对照临床研究纳入本文荟萃分析。荟萃分析发现,按需间断吸入糖皮质激素(实验组)和每日规律吸入糖皮质激素(对照组)在哮喘加重事件发生率[OR=1.25,95%CI为0.87~1.78,P=0.22]、再住院率(OR=0.85,95%CI为0.28~2.57,P=0.77)、症状和生活质量评分改善[加权均数差(WMD)=0.02,95%CI为-0.19~0.23,P=0.88]、严重不良事件发生率(OR=0.81,95%CI为0.30~2.17,P=0.67)方面差异无统计学意义。然而,对照组呼吸峰值流速改善这一指标高于实验组(WMD=2.76,95%CI为0.69~4.82,P=0.009),而实验组在随访年限中身高的增加平均较对照组高0.51cm(WMD=-0.51,95%CI为-0.87~-0.16,P=0.005)。异质性分析提示各个研究之间同质性较好。结论按需间断吸入糖皮质激素和每日规律吸入糖皮质激素这两种治疗策略对哮喘患儿的疗效无明显差异,每日规律吸入糖皮质激素可以显著改善患儿呼吸峰值流速,但是这一疗法对患儿身高的增长可能有一定的影响。
Objectives To compare the safety and efficacy of intermittent inhaled glucocorticoid and daily inhaled glucocorticoid on demand in children with asthma. Methods We searched PubMed, the Cochrane Library, clinicaltrials.gov, and the Chinese Biomedical Literature Database to collect meta-analyzes of published articles published between 1980 and October 2013. Results According to the keyword search, a total of 943 articles were searched, and finally 4 (5 control groups) were included in the meta-analysis of the parallel design, prospective and randomized controlled clinical studies. A meta-analysis found that the incidence of exacerbations of asthma was intermittent (OR = 1.25, 95% CI 0.87 to 1.78; P = 0.22) with intermittent inhaled glucocorticoids on demand (experimental group) and daily inhaled glucocorticoid (control group) , Rehospitalization rate (OR = 0.85, 95% CI 0.28-2.57, P = 0.77), improvement in symptoms and quality of life scores [WMD = 0.02, 95% CI -0.19 to 0.23, P = 0.88]. The incidence of serious adverse events (OR = 0.81, 95% CI 0.30-2.17, P = 0.67) showed no significant difference. However, in the control group, the index of peak respiratory flow was higher than that of the control group (WMD = 2.76, 95% CI 0.69-4.82, P = 0.009), while the increase of height in the experimental group was 0.51 cm (WMD = -0.51, 95% CI -0.87 -0.16, P = 0.005). Heterogeneity analysis suggests good homogeneity among studies. Conclusion The intermittent inhalation of glucocorticoids and daily inhaled glucocorticoid on the basis of the two treatment strategies for children with asthma no significant difference in the efficacy of regular daily inhaled glucocorticoid can significantly improve the respiratory flow peak velocity in children, Therapy may have a certain impact on the growth of children.