糠酸莫米松干粉吸入治疗轻中度哮喘的疗效和安全性 Meta分析

摘要

目的：评价糠酸莫米松干粉吸入（MF DPI）治疗轻中度哮喘的疗效和安全性。方法检索PubMed、EMBASE、CI‐NAHL等数据库，收集MF DPI治疗轻中度哮喘的随机对照试验，按Cochrane系统评价方法进行质量评价和资料提取。统计学分析采用RevMan5．0．2软件。结果共纳入9个随机对照试验研究，包括1795例轻中度哮喘患者。Meta分析结果显示：与安慰剂相比，MF DPI 200 mcg／d改善第一秒用力呼气容积（FEV1）（MD＝0．24，95％ CI：0．17～0．30）、清晨呼气峰值流速（amPEF）（MD＝25．25，95％ CI：8．18～42．32）、夜间呼气峰值流速（pmPEF）（MD＝16．00，95％ CI：2．10～29．90）优于安慰剂；MF DPI 400 mcg／d改善FEV1（MD＝0．32，95％ CI：0．25～0．39）、amPEF（MD＝36．44，95％ CI：23．82～49．05）、pmPEF（MD＝28．50，95％CI：14．11～42．89）优于安慰剂。对于减少患者清晨呼吸困难和减少沙丁胺醇用量，MF DPI 200 mcg／d和MF DPI 400 mcg／d均优于安慰剂；而减少患者清晨喘鸣，M F DPI 200 mcg／d和M F DPI 400 mcg／d并不优于安慰剂。对于不良事件的发生，M F DPI 200 mcg／d、MF DPI 400 mcg／d和安慰剂比较差异无统计学意义（P＞0．05）。结论现有证据表明，MF DPI治疗轻中度持续哮喘疗效及安全性较高。%Objective To evaluate the efficacy and safety of mometasone furoate dry powder inhalation(MF DPI) in treating mild and moderate asthma .Methods The databases of PubMed ,EMBASE ,CINAHL were retrieved .The randomized ,controlled trials(RCT) on mometasone furoate dry powder inhalation in treating mild and moderate asthma were collected .The quality evalua‐tion and the data extraction were performed according to the Cochrane systematic evaluation method .The RevMan 5 .0 .2 software was adopted for conducting statistical analysis .Results A total of 9 RCT involving 1 795 patients with mild and moderate asthma were included .The meta‐analysis results showed that MF DPI 200 mcg/d improved FEV1(MD=0 .24 ,95% CI:0 .17 -0 .30) ,am‐PEF(MD= 25 .25 ,95% CI:8 .18 -42 .32) ,pmPEF(MD= 16 .00 ,95% CI:2 .10 -29 .90);MF DPI 400 mcg/d improved FEV1 (MD=0 .32 ,95% CI:0 .25-0 .39) ,amPEF(MD=36 .44 ,95% CI:23 .82-49 .05) ,pmPEF (MD=28 .50 ,95% CI:14 .11-42 .89) , which suggested that MF DPI 200 mcg/d and MF DPI 400 mcg/d improving FEV1 ,amPEF and pmPEF was higher than the place‐bo ;for reducing patient′s early morning dyspnea and albuterol dose ,MF DPI 200 mcg/d and MF DPI 400 mcg/d were superior to placebo .For reducing patient′s early morning wheezing ,MF DPI 200 mcg/d and MF DPI 400 mcg/d were not superior to placebo . For the occurrence of adverse events ,there was no statistical difference between MF DPI 200 mcg/d and MF DPI 400 mcg/d with placebo(P>0 .05) .Conclusion The existing evidence indicates that MF DPI has higher effect and safety in treating mild and mod‐erate asthma .