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目的:系统评价鼻内光疗治疗成人AR的疗效及安全性,为临床应用提供循证医学证据。方法:搜索PubMed、Embase、Cochrane图书馆、中国学术期刊全文数据库(CNKI)、万方数据库,检索鼻内光疗治疗AR的随机对照试验(RCT)或临床研究文献,截止时间为2017年3月。依据文献纳入和排除标准进行文献筛选,采用Cochrane偏倚风险评估表对纳入文献进行质量评价。用Revman 5.3软件进行Meta分析,对计量资料计算加权均数差及其95%可信区间(CI),并绘制森林图及漏斗图,对计数资料计算比值比(OR)及其95%CI,并绘制森林图及漏斗图。采用鼻症状总评分(TNSS)、鼻结膜炎生活质量问卷(RQLQ)及上颚痒评分等指标评价鼻内光疗对成人AR的治疗效果,用鼻黏膜严重干燥及轻微干燥发生率评估安全性。结果:共纳入12篇文献,其中包括5篇RCT及7篇临床研究,包括615例成人AR患者。Meta分析显示:鼻内光疗患者治疗后较治疗前TNSS、RQLQ及上颚痒评分降低,鼻黏膜轻微干燥发生率较治疗前高,差异有统计学意义(P<0.05),鼻黏膜严重干燥发生率高于治疗前,但差异无统计学意义(P>0.05)。与安慰剂及抗组胺剂组比较,鼻内光疗组患者TNSS、RQLQ及上颚痒评分降低,鼻黏膜轻微干燥发生率较高,差异有统计学意义(P<0.05),鼻黏膜严重干燥发生率较高,但差异无统计学意义(P>0.05)。结论:鼻内光疗能改善患者的TNSS、RQLQ及上颚痒症状,安全性较好。对症状缓解不满意的患者可选择使用。
Objective: To systematically evaluate the efficacy and safety of intranasal phototherapy in the treatment of adult AR and provide evidence-based medical evidence for clinical application. Methods: PubMed, Embase, Cochrane Library, CNKI, Wanfang database were searched. Randomized controlled trials (RCTs) or clinical studies searching intranasal phototherapy for AR were performed. The deadline was March 2017. The literature was screened on the basis of inclusion and exclusion criteria and the Cochrane bias risk assessment was used to assess the quality of the included literature. Meta-analysis was performed using Revman 5.3 software and the weighted mean difference and its 95% confidence interval (CI) were calculated for the metered data. Forest and funnel charts were plotted, and odds ratios (OR) and 95% CIs were calculated for the count data. And draw the forest map and funnel map. The total nasal symptom scores (TNSS), quality of life of nasal conjunctivitis questionnaire (RQLQ) and palatal itch score and other indicators evaluation of intra-nasal light therapy in adult AR treatment, nasal mucosa with severe dry and mild dry incidence rate to assess the safety. RESULTS: Twelve articles were included, including 5 RCTs and 7 clinical studies, including 615 adult AR patients. Meta-analysis showed that the incidence of nasal mucosa mild dryness was significantly higher in patients with intranasal phototherapy than that before treatment after treatment (P <0.05), the incidence of severe dry nasal mucosa Higher than before treatment, but the difference was not statistically significant (P> 0.05). Compared with placebo and antihistamine group, the scores of TNSS, RQLQ and palatal itch in nasal phototherapy group were lower, the incidence of mild nasal mucosa was higher, the difference was statistically significant (P <0.05), severe dry nasal mucosa occurred The rate was higher, but the difference was not statistically significant (P> 0.05). Conclusion: Intra-nasal light therapy can improve the symptoms of TNSS, RQLQ and palate of the upper jaw in patients with better safety. Patients who are dissatisfied with symptoms may choose to use it.