摘要
目的 荟萃分析抗反流药物治疗对支气管哮喘（简称哮喘）伴胃食管反流患者哮喘症状的影响.方法纳入对合并胃食管反流的哮喘患者行抗反流治疗的前瞻性随机对照试验,抗反流治疗干预要求使用双肓法,样本量大小、匹配方式不限,研究对象为年龄＞13岁的伴胃食管反流病的哮喘患者.检索PubMed数据库、Embase数据库、Cochrane图书馆临床对照试验数据库、OVID数据库、中国生物医学文献数据库、中国知网全文数据库、万方科技期刊全文数据库.手工检索〈中华结核和呼吸杂志〉、〈中华消化杂志〉、〈中华内科杂志〉、CHEST及纳入文献的参考文献.所有检索均截至2009年11月.排除研究对象在进入研究前3 d内服用过抗反流药物、重复或多重发表、方法学质量评价为B级以下的文献.运用Cochrane荟萃分析的方法,由2名评价员独立对试验进行筛选、质量评价、数据提取和交叉核对.使用Revman 4.3.2软件对数据合并进行统计分析,评价抗反流药物治疗对哮喘伴胃食管反流患者哮喘的疗效.结果共纳入14项临床随机对照试验,包括1555例患者.抗反流治疗组与安慰剂组相比,FEV1增加[加权均数差（WMD）为0.11 L;95%可信区间（95%CI）为0.02～0.20;Z=2.49,P=0.010];日间最大呼气流速（PEF）增加（WMD为42.33 L/min;95%CI为3.39～81.28;Z=2.13,P=0.030）;早晨PEF增加（WMD为16.16 L/min;95%CI为5.91～26.41;Z=3.09,P=0.002）;夜间PEF增加（WMD为18.35 L/min;95%CI为6.77～29.92;Z=3.11,P=0.002）.抗反流治疗与安慰剂治疗后比较,FEV1较基础对照值降低达20%时的吸入乙酰胆碱浓度（PC20-FEV1）减低（WMD为-0.07 mg/L;95%CI为-0.33～0.19）,但差异无统计学意义（Z=0.55,P=0.590）.14项研究中有8项研究在抗反流治疗后观察到哮喘症状改善,但荟萃分析显示哮喘日间症状和夜间症状的改善均无统计学意义.结论抗反流治疗可改善合并胃食管反流病哮喘患者的肺通气功能,但对气道高反应性和哮喘症状无显著影响.
Objective To evaluate the effect of antireflux treatment in asthma patients with gastroesophageal reflux disease （GERD）.Methods Prospective randomized trials of antireflux treatment in asthma patients with gastroesophageal reflux were all included.Antireflux treatment should be doubleblinded.Sample size and matching ways were not restricted.The study subjects were defined as asthmatic patients with gastroesophageal reflux aged 13 or older.Computer searching included The Cochrane Central Register of Controlled Trials,PubMed,Embase,OVID database,Chinese Biological Medicine database （CBMdisc）,China National Knowledge Infrastructure （CNKI）,and Wanfang Data.Manual searching included Chinese Journal of Tuberculosis and Respiratory Diseases,Chinese Journal of Digestion,Chinese Journal of Internal Medicine,CHEST and the references of trails included.The search ended on November of 2009.Trials with subjects using antireflux drugs in 3 days before entry,trials repeatly or mutiply published,and trials with methodology quality under grade B were excluded.With the method of Cochrane systematic review,2 reviewers assessed the quality of the studies,extracted data independently and crosschecked the data.Data were combined and analyzed with RevMan 4.3.2 to evaluate the effect of antireflux treatment on asthmatic patients with gastroesophageal reflux disease.Results Fourteen randomized controlled studies met inclusion criteria,including 1555 cases.Meta-analyses demonstrated that antireflux treatment improved the pulmonary function in asthmatics with gastroesophageal reflux.Compared to the placebo group,FEV1 improved [WMD 0.11 L;95 % CI （0.02 - 0.20）;Z= 2.49,P = 0.010];and PEF also improved,including daytime PEF [WMD 42.33 L/min;95% CI （ 3.39 - 81.28 ）,Z = 2.13,P =0.030],morning PEF[WMD 16.16 L/min;95% CI （5.91 - 26.41）;Z = 3.09,P = 0.002],and nighttime PEF[WMD 18.35 L/min;95% CI （ 6.77 - 29.92）;Z = 3.11,P = 0.002].However,no significant difference was found in the decrease of provocative concentration of acetylcholine causing a 20% decrease in FEV1 （ PC20-FEV1 ） [WMD -0.07 mg/L;95% CI （ -0.33 -0.19）;Z = 0.55,P = 0.590].Eight out of 14 studies showed improvement in asthma symptoms after antireflux treatment,but neither daytime symptoms nor nighttime symptoms showed significant improvement in this Meta-analysis.Conclusion Antireflux treatment in asthmatics with gastroesophageal reflux could improve pulmonary function,but showed no significant effect on airway hyper-responsiveness or asthma symptoms.
出处
《中华结核和呼吸杂志》
CAS
CSCD
北大核心
2010年第11期823-830,共8页
Chinese Journal of Tuberculosis and Respiratory Diseases
关键词
哮喘
胃食管反流
Meta分析
抗反流治疗
Asthma
Gastroesophageal reflux
Meta-analysis
Antireflux treatment
