Aljebab Fahad, Choonara Imti, Conroy Sharon
Division of Medical Sciences & Graduate Entry Medicine, School of Medicine, University of Nottingham, Royal Derby Hospital Centre, Derby, United Kingdom.
PLoS One. 2017 Jan 26;12(1):e0170259. doi: 10.1371/journal.pone.0170259. eCollection 2017.
Long courses of oral corticosteroids are commonly used in children in the management of chronic conditions. 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 Embase, Medline, International Pharmaceutical Abstracts, CINAHL, Cochrane Library and PubMed was performed with no language restrictions in order to identify studies where oral corticosteroids were administered to patients aged 28 days to 18 years of age for at least 15 days of treatment. Each database was searched from their earliest dates to January 2016. All studies providing clear information on ADRs were included.
One hundred and one studies including 33 prospective cohort studies; 21 randomised controlled trials; 21 case series and 26 case reports met the inclusion criteria. These involved 6817 children and reported 4321 ADRs. The three ADRs experienced by the highest number of patients were weight gain, growth retardation and Cushingoid features with respective incidence rates of 21.1%, 18.1% and 19.4% of patients assessed for these ADRs. 21.5% of patients measured showed decreased bone density and 0.8% of patients showed osteoporosis. Biochemical HPA axis suppression was detected in 269 of 487 patients where it was measured. Infection was the most serious ADR, with twenty one deaths. Varicella zoster was the most frequent infection (9 deaths).
Weight gain, growth retardation and Cushingoid features were the most frequent ADRs seen when long-course oral corticosteroids were given to children. Increased susceptibility to infection was the most serious ADR.
长期口服皮质类固醇常用于儿童慢性病的治疗。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。
对Embase、Medline、国际药学文摘、护理学与健康领域数据库（CINAHL）、Cochrane图书馆和PubMed进行文献检索，无语言限制，以确定对28天至18岁患者至少给予15天口服皮质类固醇治疗的研究。每个数据库从最早日期检索至2016年1月。纳入所有提供明确ADR信息的研究。
101项研究符合纳入标准，包括33项前瞻性队列研究、21项随机对照试验、21项病例系列研究和26项病例报告。这些研究涉及6817名儿童，报告了4321例ADR。报告ADR的患者中，出现次数最多的三种ADR是体重增加、生长发育迟缓及库欣样特征，评估这些ADR的患者发生率分别为21.1%、18.1%和该19.4%。测量显示21.5%的患者骨密度降低，0.8%的患者出现骨质疏松。在4中测量的487名患者中，检测到269名患者出现生化下丘脑-垂体-肾上腺（HPA）轴抑制。感染是最严重的ADR，导致21人死亡。水痘带状疱疹是最常见的感染（9例死亡）。
给儿童长期口服皮质类固醇时，体重增加、生长发育迟缓及库欣样特征是最常见的ADR。感染易感性增加是最严重的ADR。
