摘要
目的系统评价孟鲁司特治疗成人哮喘急性发作的疗效和安全性。方法计算机检索Pubmed、Embase、Web of Science、OVID和Cochrane图书馆等电子数据库,查找应用孟鲁司特与安慰剂治疗成人哮喘急性发作期患者的随机对照试验(RCT)。对符合条件的RCT,由2名研究者独立进行资料提取和质量评价,采用RevMan 5.1软件进行Meta分析,采用GRADE指南对证据质量和等级推荐进行分级,计算相关临床结局的需要处理的例数(NNT)。结果共纳入5个RCT(n=947)的成人哮喘急性发作患者。Meta分析结果显示,与安慰剂比较,孟鲁司特能明显改善哮喘急性发作的呼气峰流速(MD=10.65[2.81,18.49],P=0.008)和减少全身糖皮质激素的使用(RR=0.75[0.62,0.92],NNT=7[4,46],P=0.005),但在减少住院治疗(RR=0.78[0.57,1.06],NNT=19[9,+∞],P=0.110)及治疗失败(RR=0.85[0.67,1.09],NNT=17[9,+∞],P=0.314)方面差异无统计学意义。GRADE证据级别及推荐强度结果显示,证据水平为低～中等,推荐等级为弱推荐。结论孟鲁司特能改善哮喘急性发作时的肺功能,且可减少口服糖皮质激素使用,而有关减少住院治疗和治疗失败的临床疗效有待进一步研究。
Objective To systematically evaluate the efficacy and safety of montelukast in the treatment of acute asthma in adults. Methods Randomized controlled trials （RCTs） of montelukast in the treatment of acute asthma compared with placebo were searched in Pubmed, Embase, OVID, and Cochrane Library. The quality of included RCTs was evaluated and the data were extracted. Meta-analyses were performed with RevMan 5.1 software, and the GRADE system was applied to rate the level of evidence and strength of recommendation. Results Five RCTs （ n = 947 ） were included. Meta-analyses showed that montelukast could statistically improve peak expiratory flow （PEF） （ MD = 10. 65 [ 2. 81,18.49 ], P = 0. 008 ）, reduce the number of patients with oral corticosteroids （ RR = 0. 75 [ 0. 62,0. 92 ], NNT = 7 [ 4,46 ], P = 0. 005 ）, but there were no statistical differences in decreasing the number of patients with hospitalizations （RR=0.78[0.57,1.06] ,NNT = 1919, ＋ ∞ ] ,P =0. 110） and treatment failure （RR =0.85[0.67, 1.09 ], NNT = 17 [ 9, ＋ ∞ ] ,P = 0. 314 ） compared with the placebo. Based on GRADE, the level of evidence was low or moderate, and the strength of recommendation was weak. Conclusion Our study suggests montelukast can improve the lung function and reduce the use of systematic corticosteroids in acute asthma, but the potency to reduce the number of patients with hospitalization and treatment failure need to be explored in future.
出处
《中国呼吸与危重监护杂志》
CAS
2012年第4期335-341,共7页
Chinese Journal of Respiratory and Critical Care Medicine
基金
国家自然科学基金(编号:30971326、30901907)
四川省青年基金资助计划(编号:2010JQ0008)
四川大学优秀青年学者基金(编号:2011SCU04B17)
