摘要
目的通过系统评价的方法,比较布地奈德(BUD)与全身性激素(SCS)治疗COPD急性加重期(AECOPD)的有效性与安全性。方法计算机检索Pub Med、Web of Science、中国知网、维普网、中国生物医学文献数据库(CBM)中关于BUD(试验组)与SCS(对照组)治疗AECOPD的文献,检索时间均从建库至2014年7月。提取肺功能、动脉血气分析、呼吸困难评分、COPD评估测试(CAT)问卷评分、不良反应资料。结果纳入19篇符合标准的文献。Meta分析结果显示,两组治疗前后第1秒用力呼气末容积(FEV1)差值比较,治疗疗程非7天亚组与7天亚组均无统计学意义〔MD=-0.03,95%CI(-0.11,0.05),P=0.45;MD=-0.01,95%CI(-0.06,0.03),P=0.61〕。两组治疗前后第1秒用力呼气末容积占预计值百分比(FEV1%)差值比较,治疗疗程非7天亚组与7天亚组均无统计学意义〔MD=-0.80,95%CI(-2.62,1.02),P=0.39;MD=-0.21,95%CI(-1.44,1.03),P=0.74〕。两组治疗前后动脉血氧分压(Pa O2)差值比较,治疗疗程非7天亚组与7天亚组均有统计学意义〔MD=-2.12,95%CI(-4.14,-0.10),P=0.04;MD=-1.06,95%CI(-1.85,-0.26),P=0.01〕。两组治疗前后动脉血二氧化碳分压(Pa CO2)差值比较,治疗疗程非7天亚组与7天亚组均无统计学意义〔MD=-0.44,95%CI(-1.13,0.26),P=0.22;MD=0.00,95%CI(-0.58,0.57),P=0.99〕。两组治疗前后呼吸困难评分差值比较,差异无统计学意义〔MD=-0.02,95%CI(-0.18,0.13),P=0.76〕。两组治疗前后CAT差值比较,差异无统计学意义〔MD=0.34,95%CI(-0.23,0.92),P=0.24〕。对照组不良反应主要表现为血糖升高、胃部不适和口干;试验组不良反应主要为口腔、咽部及胃部不适。结论 BUD和SCS均可改善AECOPD患者肺功能及动脉血气、减轻呼吸困难和降低CAT评分,两者疗效差异不明显,BUD不良反应较SCS少。
Objective To systematically review the efficacy and safety of budesonide（ BUD） and systemic corticosteroids（ SCS） on patients with AECOPD. Methods We searched literature concerning studies in which patients with AECOPD receiving BUD treatment were assigned as trial group and SCS as control group from Pub Med,Web of Science,CNKI,VIP database and CBM Data with the time range of searching set from establishment of the databases to July 2014. The extracted data covered pulmonary function analysis, arterial blood gas analysis, score of dyspnea, score of CAT and adverse events.Results A total of 19 pieces of valid literature were included. The meta analysis showed that there was no significant difference in FEV1 before and after treatment either in non- seven- day treatment subgroup or seven- day treatment subgroup 〔MD =- 0. 03,95% CI（- 0. 11,0. 05）, P = 0. 45; MD =- 0. 01,95% CI（- 0. 06,0. 03）, P = 0. 61 〕; there was nosignificant difference in FEV1% before and after treatment either in non- seven- day treatment subgroup or seven- day treatment subgroup 〔MD =- 0. 80,95% CI（- 2. 62,1. 02）,P = 0. 39; MD =- 0. 21,95% CI（- 1. 44,1. 03）,P = 0. 74 〕;there was significant difference in Pa O2 before and after treatment both in non- seven- day treatment subgroup and seven- day treatment subgroup 〔MD =- 2. 12,95% CI（- 4. 14,- 0. 10）,P = 0. 04; MD =- 1. 06,95% CI（- 1. 85,- 0. 26）,P= 0. 01〕; there was no significant difference in Pa CO2 before and after treatment either in non- seven- day treatment subgroup or seven- day treatment subgroup 〔MD =- 0. 44,95% CI（- 1. 13,0. 26）,P = 0. 22; MD = 0. 00,95% CI（- 0. 58,0. 57）,P = 0. 99〕; there was no significant difference in the scores of dyspnea 〔MD =- 0. 02,95% CI（- 0. 18,0. 13）,P= 0. 76〕; there was no significant difference in CAT 〔MD = 0. 34,95% CI（- 0. 23,0. 92）,P = 0. 24 〕. For trial group,the adverse events were mainly increasing level of blood glucose,stomach upset and xerostomia; for control group,the adverse events were mainly discomfort in oral cavity,throat and stomach. Conclusion BUD and SCS are both effective in improving pulmonary function and arterial blood gas,alleviating dyspnea and reducing CAT score in patients with AECOPD. The difference in the effects is not statistically significant and BUD causes less adverse events than SCS.
出处
《中国全科医学》
CAS
CSCD
北大核心
2015年第8期873-880,共8页
Chinese General Practice
基金
国家自然科学基金面上项目(81173390)
上海市恽氏中西医汇通项目
关键词
布地奈德
全身性激素
肺疾病
慢性阻塞性
疗效比较研究
META分析
Budesonid
Systemic corticosteroids
Pulmonary disease
chronic obstructive
Comparative effectiveness research
Meta-analysis
