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目的系统评价急性期吸入糖皮质激素对急性毛细支气管炎后喘息的预防作用。方法检索PubMed、Medline、Embase和Cochrane Library、中国生物医学文献数据库(CBM)、中国期刊全文数据库(CNKI)、中文科技期刊数据库(VIP)和万方数据库,并辅以手工检索,检索时间均从建库至2012年12月31日,收集有关吸入糖皮质激素预防毛细支气管炎后喘息的随机对照试验,并对纳入的文献进行质量评价,应用Stata 12.0软件对资料进行Meta分析。结果共纳入7篇RCT。总样本量为719例,其中吸入激素治疗组361例,对照组358例。Meta分析结果显示吸入激素不能减少再发喘息的发生率(RR=1.02,95%CI:0.89~1.17,P=0.742),也不能减少再住院率(RR=1.09,95%CI:0.74~1.59,P=0.672)、激素使用率(RR=0.95,95%CI:0.76~1.17,P=0.612)以及支气管扩张剂的使用率(RR=1.05,95%CI:0.81~1.36,P=0.712),两组间差异无统计学意义。所有的RCT均无严重不良事件报道。结论现有的证据不足以支持吸入糖皮质激素能预防毛细支气管炎后喘息的发生,但结论的可靠性仍需大样本、多中心的、高质量的RCT进一步证实。
Objective To evaluate the preventive effect of inhaled corticosteroids in the acute phase on wheezing after acute bronchiolitis. Methods PubMed, Medline, Embase and Cochrane Library, Chinese CBM, CNKI, VIP and Wanfang databases were retrieved and retrieved manually from Building a database to December 31, 2012, to collect randomized controlled trials on inhalation of glucocorticoid to prevent wheezing after bronchiolitis, and to evaluate the quality of the included literature, Meta-analysis of the data using Stata 12.0 software. Results A total of 7 RCTs were included. The total sample size was 719 cases, of which 361 cases were inhaled hormone therapy group and 358 cases in control group. Meta-analysis showed that inhaled corticosteroids did not reduce the incidence of recurrent wheeze (RR = 1.02, 95% CI: 0.89 to 1.17, P = 0.742) nor did they reduce the rate of rehospitalization (RR = 1.09; 95% CI: 0.74 to 1.59 (RR = 1.05, 95% CI: 0.81-1.36, P = 0.712), and the use of bronchodilators (RR = 0.95,95% CI: 0.76-1.17, P = There was no significant difference between the two groups. None of the RCTs reported serious adverse events. Conclusions There is insufficient evidence available to support the inhalation of glucocorticoids to prevent wheezing after bronchiolitis, but the reliability of the conclusions still needs large sample size, and multicenter, high-quality RCT further confirms.