Mener David J, Shargorodsky Josef, Varadhan Ravi, Lin Sandra Y
Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD.
Int Forum Allergy Rhinol. 2015 Feb;5(2):95-103. doi: 10.1002/alr.21430. Epub 2014 Nov 3.
There is no consensus regarding the effects on growth velocity of intranasal topical corticosteroid (ITC) use in children. The objective of this study was to determine whether ITC use reduces growth velocity in children with allergic rhinitis (AR).
A literature search of the National Center for Biotechnology Information PubMed, EMBASE, SCOPUS, and Cochrane databases from January 1, 1988 to October 7, 2013. The study selection was composed of randomized clinical trials investigating ITC for treatment of AR in children (age <18 years of age) with appropriate controls. Studies must have included interval change in growth as an outcome. Two authors independently extracted data and assessed study quality. Eligible studies were pooled using a random-effects approach.
Eight studies with 755 participants from 3 countries provided data for the meta-analysis (knemometry, n =342 participants; stadiometry, n =413 participants). Study duration ranged from 2 to 4 weeks for trials evaluating knemometry outcomes, and 12 months for trials evaluating stadiometry outcomes. Age of participants ranged from 3 to 12 years. The pooled standardized mean difference showed that among studies using knemometry, mean growth was statistically significantly lower among children using ITC vs placebo (-.223 mm/week; 95% confidence interval [CI], -0.429 to -0.017; p < 0.034).The pooled standardized mean difference showed that among studies using stadiometry, there was no significant growth difference among children using ITC vs placebo (-0.053 cm/year; 95% CI, -0.491 to 0.385; p = 0.813). The limitations of this study were the difficulty in predicting longer-term or catch-up growth in children.
Meta-analytic pooling of trials suggest that short-term ITC for the treatment of AR in children may decrease short-term growth velocity using knemometry; however, the effect on longer-term growth velocity as measured by stadiometry is unclear.
关于鼻内局部使用皮质类固醇（ITC）对儿童生长速度的影响，目前尚无共识。本研究的目的是确定使用ITC是否会降低过敏性鼻炎（AR）患儿的生长速度。
检索美国国立生物技术信息中心的PubMed、EMBASE、SCOPUS和Cochrane数据库，检索时间范围为1988年1月1日至2013年10月7日。研究选择包括调查ITC治疗儿童（年龄<18岁）AR并设有适当对照的随机临床试验。研究必须将生长的间隔变化作为一项结果指标。两位作者独立提取数据并评估研究质量。采用随机效应方法对符合条件的研究进行汇总分析。
来自3个国家的8项研究共755名参与者为荟萃分析提供了数据（测小腿长度，n = 342名参与者；测身高，n = 413名参与者）。评估小腿长度结果的试验研究持续时间为2至4周，评估身高结果的试验为12个月。参与者年龄范围为3至12岁。汇总的标准化均差显示，在使用小腿长度测量的研究中，使用ITC的儿童平均生长速度在统计学上显著低于使用安慰剂的儿童（-0.223毫米/周；95%置信区间[CI]，-0.429至-0.017；p < 0.034）。汇总的标准化均差显示，在使用身高测量的研究中，使用ITC的儿童与使用安慰剂的儿童之间生长无显著差异（-0.053厘米/年；95%CI，-0.491至0.385；p = 0.813）。本研究的局限性在于难以预测儿童的长期生长或追赶生长情况。
试验的荟萃分析表明，短期使用ITC治疗儿童AR可能会降低使用小腿长度测量的短期生长速度；然而，通过身高测量对长期生长速度的影响尚不清楚。
