Wei Weili, Liu Ruilin, ZhangTong Yangzi, Qiu Zhongmin
Department of Respiratory Medicine, Tongji Hospital, Tongji University School of Medicine, Shanghai 200065, China.
J Thorac Dis. 2016 Oct;8(10):2942-2951. doi: 10.21037/jtd.2016.10.51.
There have been several published reports on the use of orally administered, specific centrally acting medicines for the treatment of idiopathic cough; however, there is no extant systematic review of randomized controlled trials (RCTs) that evaluated their efficacy and safety for the treatment of idiopathic cough in human beings.
We conducted a series of definitive systematic reviews and meta-analyses of RCTs. Claims data from the MEDLINE, EMBASE, LILACS, CBM, CNKI, VIP, Wan Fang, and Cochrane Library databases were used. We also reviewed articles and reference lists of relevant articles pertaining to human subjects published prior to March 26, 2016. No language restrictions were imposed. Two authors independently reviewed the titles and abstracts of the retrieved studies, which were matched using Review Manager 5.3 software. Disagreements were resolved by consensus. The outcome data were the number of subjects whose symptoms declined, measured by cough or Leicester Cough Questionnaire (LCQ) score. Random effect meta-analyses were used to pool the findings. Publication bias was assessed using funnel plots.
Three RCTs, regarding the medicines baclofen, amitriptyline, and gabapentin, were conducted involving 92 persons in total. Our reviews confirmed that baclofen, amitriptyline, and gabapentin show promise in the treatment of cough for select cases of refractory chronic cough. After-treatment relief of cough symptoms was significant (risk ratio =2.41; 95% CI: 1.15-5.04, n=84). Each of the medicines was well tolerated with minimal side effects. Methodological biases in the design and execution of cluster randomized trials might contribute to any selection bias in this review.
Baclofen, amitriptyline, and gabapentin may be effective 'non-specific' antitussives in clinical settings, although none of them are used in medical assessments or routinely included in the anatomic diagnostic protocol.
已有多篇关于口服特定中枢性药物治疗特发性咳嗽的报道；然而，尚无对评估其治疗人类特发性咳嗽疗效和安全性的随机对照试验（RCT）进行的系统评价。
我们对RCT进行了一系列确定性系统评价和荟萃分析。使用了MEDLINE、EMBASE、LILACS、CBM、CNKI、VIP、万方和Cochrane图书馆数据库中的索赔数据。我们还查阅了2016年3月26日前发表的有关人类受试者的文章及相关文章的参考文献列表。未设语言限制。两名作者独立查阅检索到的研究的标题和摘要，使用Review Manager 5.3软件进行匹配。分歧通过协商解决。结局数据为症状减轻的受试者数量，通过咳嗽或莱斯特咳嗽问卷（LCQ）评分衡量。采用随机效应荟萃分析汇总研究结果。使用漏斗图评估发表偏倚。
开展了三项关于巴氯芬、阿米替林和加巴喷丁的RCT，共涉及92人。我们的评价证实，巴氯芬、阿米替林和加巴喷丁在治疗某些难治性慢性咳嗽病例的咳嗽方面显示出前景。治疗后咳嗽症状缓解显著（风险比=2.41；95%CI：1.15 - 5.04，n = 84）。每种药物耐受性良好，副作用极小。整群随机试验设计和实施中的方法学偏倚可能导致本评价中的任何选择偏倚。
巴氯芬、阿米替林和加巴喷丁在临床环境中可能是有效的“非特异性”镇咳药，尽管它们均未用于医学评估或常规纳入解剖学诊断方案。
