Aljebab Fahad, Choonara Imti, Conroy Sharon
University of Nottingham.
Arch Dis Child. 2016 Sep;101(9):e2. doi: 10.1136/archdischild-2016-311535.57.
Long courses of oral corticosteroids are commonly used in children in the management of conditions such as nephrotic syndrome, leukaemia, asthma and others. Various adverse drug reactions (ADRs) are known to occur with their use. This systematic review aimed to identify the most common and serious ADRs and to determine their relative risk levels.
A literature search of several databases; Embase, Medline, International Pharmaceutical Abstracts, CINAHL, the Cochrane Library and PubMed was performed to identify all studies where corticosteroids had been administered to paediatric patients ranging from 28 days to 18 years of age for at least 15 days of treatment. Each database was searched from their earliest dates to March 2014. All types of studies that provided clear information on ADRs were included.
91 relevant studies were found from 27 countries. These studies represented a total of 6653 children and contained reports of 4124 ADRs, the majority in patients with leukaemia, haemangioma and asthma. Oral prednisolone was the most commonly prescribed corticosteroid (74% of patients). The three most frequent ADRs were weight gain, Cushingoid features and growth retardation. The incidence rates of patients with these three ADRs were 22.4%, 20.6% and 18.9%, respectively. Increased susceptibility to infection was the most serious ADR. 24 children died from infections, ten from varicella zoster and the others from different microorganisms.
Weight gain, Cushingoid features and growth retardation were the most frequent ADRs seen when long-course oral corticosteroids were given to children. In addition, increased susceptibility to infection was the most common cause of mortality.
长期口服皮质类固醇常用于儿童肾病综合征、白血病、哮喘等疾病的治疗。已知使用这些药物会发生各种药物不良反应（ADR）。本系统评价旨在确定最常见和最严重的ADR，并确定其相对风险水平。
检索了多个数据库；Embase、Medline、国际药学文摘、护理学与健康领域数据库、Cochrane图书馆和PubMed，以确定所有对28天至18岁儿科患者使用皮质类固醇进行至少15天治疗的研究。每个数据库从最早日期检索至2014年3月。纳入所有提供了关于ADR明确信息的各类研究。
从27个国家找到了91项相关研究。这些研究共涉及6653名儿童，包含4124例ADR报告，大多数发生在白血病、血管瘤和哮喘患者中。口服泼尼松龙是最常用的皮质类固醇（74%的患者）。三种最常见的ADR是体重增加、库欣样特征和生长发育迟缓。这三种ADR的发生率分别为22.4%、20.6%和18.9%。感染易感性增加是最严重的ADR。24名儿童死于感染，10名死于水痘带状疱疹，其他死于不同微生物感染。
对儿童长期口服皮质类固醇时，体重增加、库欣样特征和生长发育迟缓是最常见的ADR。此外，感染易感性增加是最常见的死亡原因。
