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目的系统评价噻托溴铵治疗成人哮喘的有效性和安全性。方法计算机检索Pubmed、EMbase、Cochrane图书馆、Clinical Trials.gov、中国知网、万方数据库、维普中文数据库,收集噻托溴铵治疗成人哮喘的临床随机对照试验(RCTs),检索时间为建库至2014年9月,同时手工检索相关研究的参考文献。采用改良Jadad量表评分对纳入RCTs的偏倚风险进行评价,对文献进行质量评价,并使用Revman5.3软件进行Meta分析。结果共纳入符合标准的RCTs 9个,共计患者4 392例。Meta分析结果显示,与安慰剂相比,噻托溴铵治疗成人哮喘能显著改善患者第一秒用力呼气容积(FEV1谷值,WMD=0.11,95%CI:0.09~0.14,P<0.000 01;FEV1峰值,WMD=0.15,95%CI:0.13~0.18,P<0.000 01)、最大呼气流速(PEF晨起,WMD=19.97,95%CI:14.26~25.68,P<0.000 01;PEF夜间,WMD=25.02,95%CI:19.23~30.80,P<0.000 01)及哮喘控制问卷评分(WMD=-0.12,95%CI:-0.18~-0.05,P=0.000 6),显著减少一般不良反应的发生(OR=0.73,95%CI:0.62~0.87,P=0.000 3)。噻托溴铵和安慰剂在对哮喘生命质量问卷评分和严重不良反应发生方面无明显差异(P>0.05)。结论噻托溴铵治疗成人哮喘,可明显改善患者肺功能、症状和生活质量,且安全有效。
Objective To evaluate the efficacy and safety of tiotropium in the treatment of adult asthma. Methods Pubmed, EMbase, Cochrane Library, Clinical Trials.gov, CNKI, Wanfang database and VIP database were searched by computer. Randomized controlled trials (RCTs) were collected for the treatment of adult asthma with tiotropium. The retrieval time was By September 2014, the relevant studies were manually searched for references. The modified Jadad scale was used to assess the risk of bias in inclusion of RCTs, the quality of the literature was evaluated, and Meta-analysis was performed using Revman 5.3 software. Results A total of 9 eligible RCTs were included, with a total of 4 392 patients. Meta-analysis showed that tiotropium treatment of adult asthma significantly improved first-quarter forced expiratory volume (FEV1 trough, WMD = 0.11, 95% CI: 0.09-0.14, P <0.000 01 ; Peak FEV1, WMD = 0.15, 95% CI: 0.13-0.18, P <0.000 01), maximum expiratory flow rate (PEF morning, WMD = 19.97, 95% CI: 14.26-25.68, P < , WMD = 25.02, 95% CI: 19.23-30.80, P <0.000 01) and asthma control questionnaire score (WMD = -0.12,95% CI: -0.18-0.05, P = 0.0006), significantly reduced the common adverse reactions (OR = 0.73, 95% CI: 0.62-0.87, P = 0.0003). Tiotropium bromide and placebo had no significant differences in scores of asthma quality of life questionnaire and serious adverse reactions (P> 0.05). Conclusion Tiotropium treatment of asthma in adults, can significantly improve lung function, symptoms and quality of life, and safe and effective.