Yang Mingjin, Chen Hong, Zhang Yan, Du Yuejun, Xu Ying, Jiang Ping, Xu Zhibo
a Respiratory Diseases Laboratory , Chengdu Second People's Hospital , Chengdu , China.
b Digestive System Department , Chengdu Second People's Hospital , Chengdu , China.
Inhal Toxicol. 2017 Apr;29(5):219-226. doi: 10.1080/08958378.2017.1346006. Epub 2017 Jul 17.
Recent studies have suggested that inhaled corticosteroids (ICS) may be associated with higher risks of tuberculosis and pneumonia in patients with COPD. However, it is not known whether ICS increases the risk of upper respiratory tract infection (URTI). Aim of this study was to explore the relationship between ICS and URTI. Through a comprehensive literature search of PubMed, EMBASE, Cochrane Library, and Google Scholar from inception to March 2016, we identified randomized controlled trials of ICS therapy lasting at least 6 months. A meta-analysis by the Peto approach was also conducted to generate summary estimates comparing ICS with non-ICS treatment on the risk of URTI. A total of 14 studies involving 19,777 subjects were considered in the meta-analysis. Compared with non-ICS treatment, ICS were associated with a significantly increased risk of URTI (Peto OR: 1.16; 95% CI: 1.05-1.29; I = 9%; p = .004). Subgroup analyzes were performed for different dose, high-dose ICS was associated with a significantly increased risk of URTI (Peto OR: 1.19; 95% CI: 1.05-1.34; I = 0%; p = .005), whereas low-dose ICS showed a non-significant increased risk of URTI (Peto OR: 1.10; 95% CI: 0.91-1.33; I = 0%; p = .32). Moreover, fluticasone was observed with an increased risk of URTI but not mometasone; high-dose fluticasone treatment was associated with a significantly higher risk of URTI but not low-dose. These results suggested to us that ICS use may increase the risk of URTI in patients with COPD, but it should be further investigated.
近期研究表明，吸入性糖皮质激素（ICS）可能会增加慢性阻塞性肺疾病（COPD）患者患肺结核和肺炎的风险。然而，目前尚不清楚ICS是否会增加上呼吸道感染（URTI）的风险。本研究的目的是探讨ICS与URTI之间的关系。通过对PubMed、EMBASE、Cochrane图书馆和谷歌学术进行全面的文献检索，检索时间从数据库建立至2016年3月，我们确定了持续至少6个月的ICS治疗随机对照试验。我们还采用Peto方法进行了荟萃分析，以得出ICS与非ICS治疗相比在URTI风险方面的汇总估计值。荟萃分析共纳入了14项研究，涉及19777名受试者。与非ICS治疗相比，ICS与URTI风险显著增加相关（Peto比值比：1.16；95%置信区间：1.05 - 1.29；I² = 9%；p = 0.004）。对不同剂量进行了亚组分析，高剂量ICS与URTI风险显著增加相关（Peto比值比：1.19；95%置信区间：1.05 - 1.34；I² = 0%；p = 0.005），而低剂量ICS显示URTI风险虽有增加但不显著（Peto比值比：1.10；95%置信区间：0.91 - 1.33；I² = 0%；p = 0.32）。此外，观察到使用氟替卡松会增加URTI风险，但莫米松不会；高剂量氟替卡松治疗与显著更高的URTI风险相关，但低剂量则不然。这些结果向我们表明，使用ICS可能会增加COPD患者患URTI的风险，但仍需进一步研究。
