Australian School of Advanced Medicine, Macquarie University, Sydney, Australia.
Am J Rhinol Allergy. 2013 May-Jun;27(3):221-33. doi: 10.2500/ajra.2013.27.3880.
Published randomized controlled trials (RCTs) on the efficacy of intranasal corticosteroid (INCS) in chronic rhinosinusitis (CRS) use either nasal delivery (nasal drop or nasal spray) or sinus delivery (sinus catheter or sinus irrigation) in patients with or without sinus surgery. This influences topical drug delivery and distribution. The effect of these factors on the published results of RCTs is assessed. This systematic review explores the strength of evidence supporting the influence of sinus surgery and delivery methods on the effectiveness of topical steroids in studies for CRS with meta-analyses.
A systematic review was conducted of RCTs comparing INCS with either placebo or no intervention for treating CRS. Data were extracted for meta-analysis and subgroup analyses by sinus surgery status and topical delivery methods.
Forty-eight studies (3961 patients) met the inclusion criteria. INCS improved overall symptoms (standardized mean difference [SMD], -0.49; p < 0.00001) and the proportion of responders (risk ratio [RR], 0.59; p < 0.00001) compared with placebo. It decreased nasal polyp size with a greater proportion of responders (RR, 0.48; p < 0.00001) and prevented polyp recurrence (RR, 0.59; p = 0.0004) compared with placebo. Reduction of polyp size was greater in patients with sinus surgery (RR, 0.31; 95% confidence interval [CI], 0.20, 0.48) than those without (RR, 0.61; 95% CI, 0.46, 0.81; p = 0.009). Greater symptom improvement occurred when sinus delivery methods (SMD, -1.32; 95% CI, -2.26, -0.38) were compared with nasal delivery methods (SMD, -0.38; 95% CI, -0.55, -0.22; p < 0.00001).
INCS is effective for CRS. Prior sinus surgery and direct sinus delivery enhance the effectiveness of INCS in CRS.
已发表的关于鼻腔内皮质类固醇（INCS）治疗慢性鼻-鼻窦炎（CRS）疗效的随机对照试验（RCT），要么采用鼻窦给药（鼻窦导管或鼻窦灌洗），要么采用鼻腔给药（滴鼻或鼻喷），入组患者要么接受鼻窦手术，要么未接受鼻窦手术。这两种给药方式会影响局部药物的递送和分布。本系统评价评估了这些因素对 RCT 发表结果的影响。本系统评价通过荟萃分析探讨了鼻窦手术和给药方式对皮质类固醇治疗 CRS 有效性的影响，其依据是支持这些影响的证据强度。
对比较 INCS 与安慰剂或无干预治疗 CRS 的 RCT 进行系统评价。提取数据进行荟萃分析和亚组分析，亚组分析的分组因素为鼻窦手术情况和局部给药方式。
48 项研究（3961 例患者）符合纳入标准。与安慰剂相比，INCS 可改善患者的整体症状（标准化均数差 [SMD]，-0.49；p<0.00001）和应答者比例（风险比 [RR]，0.59；p<0.00001）。与安慰剂相比，INCS 还可减小鼻息肉的大小，增加应答者比例（RR，0.48；p<0.00001），预防息肉复发（RR，0.59；p=0.0004）。与未行鼻窦手术的患者相比，行鼻窦手术的患者中鼻息肉缩小更明显（RR，0.31；95%置信区间 [CI]，0.20，0.48），而非手术患者中鼻息肉缩小的程度（RR，0.61；95%CI，0.46，0.81；p=0.009）较小。与鼻腔给药方式（SMD，-0.38；95%CI，-0.55，-0.22）相比，鼻窦给药方式（SMD，-1.32；95%CI，-2.26，-0.38）时症状改善更明显（p<0.00001）。
INCS 对 CRS 有效。鼻窦手术史和直接鼻窦给药可增强 INCS 在 CRS 中的疗效。
