大环内酯类药物对反应性气道疾病患儿的影响：一项随机对照试验的系统评价和荟萃分析。
The effects of macrolides in children with reactive airway disease: a systematic review and meta-analysis of randomized controlled trials.
作者信息
Lei Wei-Te, Lin Hsin Hui, Tsai Mu-Chieh, Hung Hua-His, Cheng Yu-Jyun, Liu Shu-Jung, Lin Chien Yu, Yeh Tzu-Lin
机构信息
Department of Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan.
Department of Family Medicine, Taipei Mackay Memorial Hospital, Taipei, Taiwan.
出版信息
Drug Des Devel Ther. 2018 Nov 8;12:3825-3845. doi: 10.2147/DDDT.S183527. eCollection 2018.
PURPOSE
Childhood reactive airway diseases (RADs) are concerning problems in children's airways and may be preceded by bronchiolitis and may progress to childhood asthma. The severity of the disease is indicated by deterioration in pulmonary functions, increased usage of rescue medications, and recurrent wheezing episodes. Macrolides have both antimicrobial and anti-inflammatory functions and have been used as adjunctive therapy in childhood RADs.
PATIENTS AND METHODS
We conducted a meta-analysis to evaluate the effect of macrolides in children with RAD. Literature searches were systematically conducted using an electronic database from inception to August 2018. The Cochrane review risk of bias assessment tool was used to assess the quality of each randomized controlled trial.
RESULTS
Sixteen randomized controlled trials comprising 1,415 participants were investigated in this meta-analysis. Children treated with macrolide therapy showed significantly better pulmonary functions in both forced expiratory volume in one second (% predicted) (difference in means=-9.77, 95% CI=-14.18 to -5.35, <0.001; =0%) and forced expiratory flow 25-75 (% predicted) (difference in means=-14.14, 95% CI=-26.11 to -2.18, =0.02; =29.56%). In addition, the short-acting β-agonist usage days and recurrent wheezing risk were significantly lowered in children with macrolide treatment (standardized difference in means=-0.34, 95% CI=-0.59 to -0.09, =0.007, =27.05% and standardized difference in means=-0.53, 95% CI=-0.81 to -0.26, <0.001, =0%, respectively). Furthermore, the growth of from nasal swabs was less in children treated with macrolides (odds ratio=0.19, 95% CI=0.11-0.35, <0.001). Children who took macrolides had a lower risk of adverse events (risk ratio=0.83, 95% CI=0.70-0.98, =0.024, =0%).
CONCLUSION
This current meta-analysis suggested that adjunctive therapy with macrolides is safe and effective for achieving better outcomes in childhood RAD.
目的
儿童反应性气道疾病（RADs）是儿童气道中令人担忧的问题，可能在细支气管炎之前出现，并可能发展为儿童哮喘。疾病的严重程度通过肺功能恶化、急救药物使用增加和反复喘息发作来表明。大环内酯类药物具有抗菌和抗炎功能，已被用作儿童RADs的辅助治疗。
患者和方法
我们进行了一项荟萃分析，以评估大环内酯类药物对RAD患儿的疗效。使用电子数据库从开始到2018年8月系统地进行文献检索。采用Cochrane综述偏倚风险评估工具评估每项随机对照试验的质量。
结果
本荟萃分析调查了16项随机对照试验，共1415名参与者。接受大环内酯治疗的儿童在一秒用力呼气量（%预测值）（均值差异=-9.77，95%CI=-14.18至-5.35，<0.001；I²=0%）和用力呼气流量25-75（%预测值）（均值差异=-14.14，95%CI=-26.11至-2.18，P=0.02；I²=29.56%）方面均显示出明显更好的肺功能。此外，接受大环内酯治疗的儿童短效β受体激动剂使用天数和反复喘息风险显著降低（均值标准化差异=-0.34，95%CI=-0.59至-0.09，P=0.007，I²=27.05%和均值标准化差异=-0.53，95%CI=-0.81至-0.26，<0.001，I²=0%）。此外，接受大环内酯治疗的儿童鼻拭子中肺炎支原体的生长较少（优势比=0.19，95%CI=0.11-0.35，<0.001）。服用大环内酯类药物的儿童不良事件风险较低（风险比=0.83，95%CI=0.70-0.98，P=0.024，I²=0%）。
结论
目前的这项荟萃分析表明，大环内酯类药物辅助治疗对改善儿童RAD的预后是安全有效的。
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