Beth Israel Deaconess Medical Center, Boston, MA.
J Asthma Allergy. 2013;6:23-9. doi: 10.2147/JAA.S38652. Epub 2013 Jan 16.
The purpose of this study was to investigate macrolides as an adjunct to an asthma controller regimen in children with asthma.
Prospective clinical trials of macrolide therapy in children with asthma using outcome measures of change in forced expiratory volume in one second (FEV(1)) and/or oral corticosteroid requirement were searched for in PubMed up to December 2009. The reference lists of studies were also included in the analysis, as well as those listed in published meta-analyses.
The literature search yielded 116 studies, six of which were included in this meta-analysis. The change in FEV(1) from baseline with adjunctive use of macrolide therapy in all children was not significant (0.25% predicted; 95% confidence interval [CI] -0.37, 0.86 predicted, P = 0.43); however, the change in FEV(1) among children receiving daily oral corticosteroids was significant (3.89% predicted; 95% CI -0.01, 7.79, P = 0.05). Addition of macrolide therapy to the treatment of children with oral corticosteroid-dependent asthma resulted in a statistically significant decrease in daily corticosteroid dosage (-3.45 mg/day; 95% CI -5.79, -1.09 mg/day, P = 0.004). This reduction in daily corticosteroid dosage was directly proportional to the duration of macrolide therapy (-0.17 mg methylprednisolone per week of macrolide therapy; 95% CI -0.33, -0.021, P = 0.025).
Addition of macrolides to the treatment regimen of children with oral corticosteroid-dependent asthma improves FEV(1) and decreases the daily dosage of corticosteroids required for control in these children. The degree of dose reduction is directly related to the duration of macrolide therapy. Additional large, randomized, placebo-controlled trials of adjunctive macrolide use in children with oral corticosteroid-dependent asthma are required to verify this observation.
本研究旨在探讨大环内酯类药物作为哮喘患儿哮喘控制药物的辅助治疗。
在 PubMed 上搜索截至 2009 年 12 月，使用一秒用力呼气量（FEV1）和/或口服皮质类固醇需求变化作为疗效评估指标的大环内酯类药物治疗儿童哮喘的前瞻性临床试验。也将研究的参考文献列表以及发表的荟萃分析中列出的内容纳入分析。
文献检索得到 116 项研究，其中 6 项纳入本荟萃分析。所有患儿使用辅助大环内酯类药物治疗的 FEV1 自基线的变化不显著（预计值的 0.25%；95%置信区间[-0.37，0.86]，P = 0.43）；然而，接受每日口服皮质类固醇治疗的患儿的 FEV1 变化则具有统计学意义（预计值的 3.89%；95%置信区间[0.01，7.79]，P = 0.05）。在依赖口服皮质类固醇治疗的儿童中，大环内酯类药物治疗的添加可使每日皮质类固醇剂量显著减少（-3.45mg/天；95%置信区间[-5.79，-1.09mg/天]，P = 0.004）。每日皮质类固醇剂量的减少与大环内酯类药物治疗的持续时间直接相关（每接受一周大环内酯类药物治疗，甲基强的松龙剂量减少 0.17mg；95%置信区间[-0.33，-0.021]，P = 0.025）。
在依赖口服皮质类固醇治疗的哮喘患儿的治疗方案中添加大环内酯类药物可改善 FEV1，并减少这些患儿控制病情所需的每日皮质类固醇剂量。剂量减少的程度与大环内酯类药物治疗的持续时间直接相关。需要开展更多的大型、随机、安慰剂对照试验，以验证辅助使用大环内酯类药物治疗依赖口服皮质类固醇的哮喘患儿的效果。
