中国基层医药
中國基層醫藥
중국기층의약
CHINESE JOURNAL OF PRIMARY MEDICINE AND PHARMACY
2012年
2期
218-221
,共4页
李洪涛%张天托%周宇麒%刘慧%黄静
李洪濤%張天託%週宇麒%劉慧%黃靜
리홍도%장천탁%주우기%류혜%황정
哮喘%糖皮质激素类%受体,肾上腺素能β2%肾上腺素能β激动剂%投药,吸入%Meta分析
哮喘%糖皮質激素類%受體,腎上腺素能β2%腎上腺素能β激動劑%投藥,吸入%Meta分析
효천%당피질격소류%수체,신상선소능β2%신상선소능β격동제%투약,흡입%Meta분석
Asthma%Glucocorticoids Inhaled%Receptors,adrenergic,beta-2%Adrenergic,beta-agonists%Administration,inhalation%Meta-analysis
目的 系统分析长效β2激动剂/吸入激素联合吸入剂(ICS/LABA)与增加吸入激素(ICS)量治疗哮喘的效果,定量评估联合治疗效能及临床安全性.方法 应用“Fluticasone and salmerterol”,“budesonide/formoterol”,“Seretide”,“Advair”,“Symbicort Turbuhaler”,联合“Randomised controlled trial”,检索1997年1月至2009年12月Medline和Embase两大数据库收录的文献.也检索了GlaxoSmithKline临床试验登记数据库、Cochrane对照研究登记数据库,并辅以文献追溯以获得另外的研究或者纳入研究的详细资料.结果 联合吸入剂组较至少增加一倍以上吸入激素组晨间呼气峰流速、晚间呼气峰流速及临床FEV1在研究终点分别增加17.59 L/min、14.95 L/min和0.08 L/min(P ＜0.01).哮喘急性发作前者较后者有统计学意义的下降,OR值为0.61(95％CI 0.53 ～0.70,P＜0.0).无症状天数、哮喘控制天数和未使用缓解症状药物天数的百分数等前者较后者分别增加6.30(95％ CI 3.52～9.10,P＜0.01)、9.49(95％ CI 4.74～14.25,P＜0.01)和6.59(95％ CI 6.10 ～7.08,P＜0.01).沙丁胺醇气雾剂的揿数下降0.22(95％CI 0.11～0.33,P＜0.01).两组总体不良反应差异无统计学意义.结论 ICS/LABA联合剂比增加ICS剂量更能改善肺功能,降低哮喘急性发作,增加哮喘控制天数,其疗效优于增加ICS剂量,且简化应用.
目的 繫統分析長效β2激動劑/吸入激素聯閤吸入劑(ICS/LABA)與增加吸入激素(ICS)量治療哮喘的效果,定量評估聯閤治療效能及臨床安全性.方法 應用“Fluticasone and salmerterol”,“budesonide/formoterol”,“Seretide”,“Advair”,“Symbicort Turbuhaler”,聯閤“Randomised controlled trial”,檢索1997年1月至2009年12月Medline和Embase兩大數據庫收錄的文獻.也檢索瞭GlaxoSmithKline臨床試驗登記數據庫、Cochrane對照研究登記數據庫,併輔以文獻追溯以穫得另外的研究或者納入研究的詳細資料.結果 聯閤吸入劑組較至少增加一倍以上吸入激素組晨間呼氣峰流速、晚間呼氣峰流速及臨床FEV1在研究終點分彆增加17.59 L/min、14.95 L/min和0.08 L/min(P ＜0.01).哮喘急性髮作前者較後者有統計學意義的下降,OR值為0.61(95％CI 0.53 ～0.70,P＜0.0).無癥狀天數、哮喘控製天數和未使用緩解癥狀藥物天數的百分數等前者較後者分彆增加6.30(95％ CI 3.52～9.10,P＜0.01)、9.49(95％ CI 4.74～14.25,P＜0.01)和6.59(95％ CI 6.10 ～7.08,P＜0.01).沙丁胺醇氣霧劑的撳數下降0.22(95％CI 0.11～0.33,P＜0.01).兩組總體不良反應差異無統計學意義.結論 ICS/LABA聯閤劑比增加ICS劑量更能改善肺功能,降低哮喘急性髮作,增加哮喘控製天數,其療效優于增加ICS劑量,且簡化應用.
목적 계통분석장효β2격동제/흡입격소연합흡입제(ICS/LABA)여증가흡입격소(ICS)량치료효천적효과,정량평고연합치료효능급림상안전성.방법 응용“Fluticasone and salmerterol”,“budesonide/formoterol”,“Seretide”,“Advair”,“Symbicort Turbuhaler”,연합“Randomised controlled trial”,검색1997년1월지2009년12월Medline화Embase량대수거고수록적문헌.야검색료GlaxoSmithKline림상시험등기수거고、Cochrane대조연구등기수거고,병보이문헌추소이획득령외적연구혹자납입연구적상세자료.결과 연합흡입제조교지소증가일배이상흡입격소조신간호기봉류속、만간호기봉류속급림상FEV1재연구종점분별증가17.59 L/min、14.95 L/min화0.08 L/min(P ＜0.01).효천급성발작전자교후자유통계학의의적하강,OR치위0.61(95％CI 0.53 ～0.70,P＜0.0).무증상천수、효천공제천수화미사용완해증상약물천수적백분수등전자교후자분별증가6.30(95％ CI 3.52～9.10,P＜0.01)、9.49(95％ CI 4.74～14.25,P＜0.01)화6.59(95％ CI 6.10 ～7.08,P＜0.01).사정알순기무제적흠수하강0.22(95％CI 0.11～0.33,P＜0.01).량조총체불량반응차이무통계학의의.결론 ICS/LABA연합제비증가ICS제량경능개선폐공능,강저효천급성발작,증가효천공제천수,기료효우우증가ICS제량,차간화응용.
Objective To provide a quantitative summary estimate on the efficacy and safety measures of the combination therapy.Methods We searched databases(Medline and Embase)from January 1997 to December 2009 using‘ Fluticasone and salmerterol' or‘ Seretide' or‘ Advair' or‘ budesonide/formoterol' or‘ Symbicort Turbuhaler' in combination with ‘ Randomised controlled trial'.The databases of GlaxoSmithKline Clinical Trial Register and Cochrane Controlled Trials Register,or relevant original studies and review articles were approached for additional studies or details of all relevant studies.Results Morning peak expiratory flow(PEF),evening PEF and clinic FEV1 were 17.59L/min,14.95L/min and 0.08L/min higher with combination therpy than with increasing ICSs by two fold or more at endpoint,respectively.The risk of asthmatic exacerbation was reduced in the combination therpy group compared with the increased doses of ICS groups,with OR being 0.61(95 ％ CI 0.53 ～ 0.70,P ＜ 0.01).Significantly increases in the percent of symptom-free days 6.30(95％ CI 3.52 ～9.10),asthma-control days 9.49(95％ CI 4.74 ～14.25)and relieve-free days 6.59(95％ CI 6.10 ～ 7.08)were observed in patients treated with ICS/LABA compared with increased doses of ICSs at endpoint.Reduction in reliever medication use(inhalations/day)0.22(95 ％ CI 0.11 ～0.33)with significant difference was also observed at endpoint.Conclusion Combination products of ICS/LABA were more effective than a high dose of ICSs in improving lung function,reducing asthmatic exacerbation and use of reliever medication and improving control of asthma.
