倍氯米松治疗儿童哮喘：对线性生长的影响。
Beclomethasone for asthma in children: effects on linear growth.
作者信息
Sharek P J, Bergman D A
机构信息
Department of Pediatrics, Stanford University, Stanford, California 94131, USA.
出版信息
Cochrane Database Syst Rev. 2000;1999(2):CD001282. doi: 10.1002/14651858.CD001282.
BACKGROUND
Inhaled steroids play a central role in the management of childhood asthma. There is concern about their side effects, especially on growth. However asthma may also cause growth retardation. Growth rates are not stable, so randomised controlled parallel group studies are needed to assess the impact of inhaled steroids on growth. This review is confine to one inhaled steroid, beclomethasone, that is known to have significant levels of systemic absorption.
OBJECTIVES
To determine whether inhaled beclomethasone cause significant delay in the linear growth of children with asthma.
SEARCH STRATEGY
The Cochrane Airways Group asthma register was searched. Bibliographies from included studies, and known reviews were searched for additional citations. Personal contact with colleagues and researchers working in the field of asthma were made to identify potentially relevant trials.
SELECTION CRITERIA
Randomized, controlled trials comparing the effects of beclamethasone to non-steroidal medication (placebo or non-steroidal therapy) on the linear growth of children with asthma.
DATA COLLECTION AND ANALYSIS
Data related to the clinical outcome "change in growth" were extracted by two reviewers working independently
MAIN RESULTS
One hundred and fifty-nine citations were identified by the search strategy and bibliography review. Three studies met the inclusion criteria. All used beclomethasone 200 mcg twice daily delivered by dry powder Diskhaler to treat children with mild-moderate asthma. Study duration was 7-12 months. In all three studies, a significant decrease in linear growth occurred in children treated with beclomethasone compared to those receiving placebo or non-steroidal asthma therapy. The average decrease, calculated through meta-analysis, was -1.54 cm per year (95% CI -1.15, -1.94).
REVIEWER'S CONCLUSIONS: In children with mild-moderate asthma, beclomethasone 200 mcg twice daily caused a decrease in linear growth of -1.54 cm per year. These studies lasted a maximum of 54 weeks, so it remains unclear whether the decrease in growth is sustained or whether it reverses with 'catch up' after therapy is discontinued. We are unable to comment on growth effects of other inhaled steroids that have potentially less systemic effects. If inhaled steroids are required to control a child's asthma, we recommend using the minimum dose that effectively controls the child's asthma and closely following growth.
背景
吸入性糖皮质激素在儿童哮喘管理中起着核心作用。人们担心其副作用，尤其是对生长的影响。然而，哮喘本身也可能导致生长发育迟缓。生长速率并不稳定，因此需要随机对照平行组研究来评估吸入性糖皮质激素对生长的影响。本综述仅限于一种已知具有显著全身吸收水平的吸入性糖皮质激素——倍氯米松。
目的
确定吸入倍氯米松是否会显著延迟哮喘儿童的线性生长。
检索策略
检索了Cochrane气道组哮喘注册库。对纳入研究的参考文献以及已知综述进行检索以获取更多引用文献。与哮喘领域的同事和研究人员进行个人联系以确定潜在的相关试验。
选择标准
比较倍氯米松与非甾体类药物（安慰剂或非甾体类治疗）对哮喘儿童线性生长影响的随机对照试验。
数据收集与分析
与临床结局“生长变化”相关的数据由两名独立工作的审阅者提取。
主要结果
通过检索策略和参考文献综述共识别出159篇引用文献。三项研究符合纳入标准。所有研究均使用每日两次、每次200微克的倍氯米松干粉吸入器（Diskhaler）治疗轻度至中度哮喘儿童。研究持续时间为7至12个月。在所有三项研究中，与接受安慰剂或非甾体类哮喘治疗的儿童相比，接受倍氯米松治疗的儿童线性生长出现显著下降。通过荟萃分析计算得出的平均下降幅度为每年-1.54厘米（95%置信区间-1.15，-1.94）。
审阅者结论
在轻度至中度哮喘儿童中，每日两次使用200微克倍氯米松导致线性生长每年下降1.54厘米。这些研究最长持续54周，因此尚不清楚生长下降是否持续，或者在停药后是否会出现“追赶”性生长逆转。我们无法对其他全身作用可能较小的吸入性糖皮质激素的生长影响发表评论。如果需要使用吸入性糖皮质激素来控制儿童哮喘，我们建议使用能有效控制儿童哮喘的最小剂量，并密切监测生长情况。
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