鼻用皮质类固醇激素联合抗组胺药对变应性鼻炎疗效的系统评价被引量：13

Effectiveness of intranasal corticosteroid plus antihistamine on allergic rhinitis: a systematic review

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摘要目的系统评价鼻内喷雾皮质类固醇激素联合口服或局部喷雾抗组胺药对变应性鼻炎的疗效。方法计算机检索Pub Med,EMbase,Google Scholar,The Cochrane Library,并手工检索相关期刊,全面收集鼻用皮质类固醇激素联合抗组胺药治疗变应性鼻炎的随机对照试验,检索时限均为建库至2015年4月。由2位评价员按照纳入与排除标准独立筛选文献、提取资料和评价纳入研究的方法学质量,采用Rev Man 5.3软件进行Meta分析。结果最终纳入10个研究,共计6568例患者。定性分析显示,相对于口服抗组胺药组或安慰剂组,联合药物治疗在改善临床症状方面有着更好的疗效。Meta分析结果显示,2个研究合并结果后联合治疗和单独鼻内激素治疗在控制症状上无明显统计学差异[WMD=-0.20,95%CI(-0.38,-0.01),P=0.04];6个随机对照试验累积Meta分析显示在提高总的鼻症状评分方面联合治疗方案分别优于单用鼻内皮质类固醇激素治疗[WMD=-1.16,95%CI(-1.49,-0.83),P<0.00001]、单用鼻内抗组胺药治疗[WMD=-1.73,95%CI(-2.08,-1.38),P<0.00001]及安慰剂组[WMD=-2.81,95%CI(-3.16,-2.47),P<0.00001]。结论对于变应性鼻炎,在减轻鼻部症状方面,鼻内皮质类固醇激素联合口服抗组胺药和单用鼻内皮质类固醇激素疗效无明显差异,但优于单用口服抗组胺药物和安慰剂组。鼻部皮质类固醇激素联合鼻部抗组胺药明显优于其他单用治疗方式,是控制变应性鼻炎鼻部症状的有效治疗措施。 Objective To systematically review the efficacy of corticosteroid nasal spray plus antihistamine versus either therapy given alone or placebo in patients with allergic rhinitis（ AR）. Methods The Pub Med,EMbase,Google Scholar and The Cochrane Library were electronically searched for randomized controlled trials（ RCTs） about the efficacy of corticosteroid plus antihistamine for AR. The duration of the search was from the inception of the databases to April 2015.After literature selection,data extraction and quality assessment conducted by two reviewers independently,meta-analysis was conducted using Rev Man 5. 3 software. Results Ten studies involving 6568 patients were finally included. The qualitative analysis showed that the combination therapy had greater efficacy than oral antihistamines alone or placebo on improving symptoms. The results of meta-analysis showed that pooled results of two trials failed to show significant difference in total nasal symptoms between combination therapy and intranasal corticosteroid alone [WMD =- 0. 20,95% CI（- 0. 38,- 0. 01）,P = 0. 04]. The cumulative meta-analysis of six RCTs showed that the combination therapy was superior to intranasal corticosteroid alone[WMD =- 1. 16,95% CI（- 1. 49,- 0. 83）,P 0. 00001 ],intranasal antihistamine alone[WMD =- 1. 73,95% CI（- 2. 08,- 1. 38）,P 0. 00001 ],and placebo [WMD =- 2. 81,95% CI（- 3. 16,- 2. 47）,P 0. 00001]. Conclusion Intranasal corticosteroid plus oral antihistamine has similar efficacy to intranasal corticosteroid alone,greater efficacy than oral antihistamines alone or placebo in reducing nasal symptoms for AR patients.Intranasal corticosteroid plus intranasal antihistamine is significantly superior to either therapy given alone or placebo.

作者简洁君伍启刚田磊郜元坤

机构地区十堰市太和医院(湖北医药学院附属医院)耳鼻喉科

出处《军事医学》 CAS CSCD 北大核心 2016年第7期573-578,共6页 Military Medical Sciences

关键词变应性鼻炎皮质类固醇激素抗组胺药投药鼻内随机对照试验系统评价 allergic rhinitis corticosteroid antihistamine administration intranasal randomized controlled trial systematic review

分类号 R765.21 [医药卫生—耳鼻咽喉科]

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