鼻腔局部應用類固醇藥物治療慢性鼻竇炎/鼻息肉和變應性鼻炎的安全性系統評價_《中國循證醫學雜志》

作者：

孟照莉 ¹ , 白玫 ² , 梁傳余 ¹

1. 四川大學華西醫院耳鼻咽喉科,成都,6100412. 內蒙古醫學院第三附屬醫院耳鼻咽喉科,內蒙古,014010;

關鍵詞：

鼻竇炎鼻息肉變應性鼻炎不良反應系統評價

視頻：

導出 下載 收藏 掃碼 引用

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

目的　系統評價鼻腔局部應用二丙氯米松、布地奈德、丙酸氟替卡松、莫米松對成人、兒童的安全性.
方法　全面系統收集全世界有關鼻腔局部應用皮質類固醇藥物的安全性的隨機對照試驗.按納入、排除標準納入合格的研究.兩個研究者獨立對納入文獻進行質量評價.資料統計分析用RevMan 4.2軟件.
結果　共納入7篇隨機對照研究,共826例.與二丙氯米松比較,成人局部使用丙酸氟替卡松發生急性鼻竇炎、鼻出血的危險性增加,但無統計學差異其值分別為OR16.18,95%CI(0.87,301.62)和OR7.76,95%CI(0.38,157.14).治療組和對照組均未發現鼻腔粘膜萎縮.成人局部使用布地奈德與安慰劑比較,鼻干、鼻出血的危險性增加,但無統計學意義,其值分別為OR 3.38,95%CI(0.66,17.8)和OR2.20,95%CI(0.39,12.32).與Pollinex-R.比較,成人局部使用布地奈德頭痛的危險性增加,但無統計學意義[OR 1.71,95%CI(0.52,5.62)].與安慰劑比較,兒童使用丙酸氟替卡松,出現鼻出血、頭痛的危險性降低,但無統計學差異,其值分別為OR0.85,95%CI(0.20,3.66)和OR0.25,95%CI(0.02,2.83);血漿中皮質類固醇濃度降低的危險性增加,但無統計學意義[OR1.56,95%CI(0.06,38.69)];丙酸氟替卡松組鼻腔粘膜干燥發生率增高,但無統計學意義[OR4.76,95%CI(0.25,89.54)];二丙氯米松與安慰劑比較,鼻干、鼻出血和鼻炎的危險性降低,但無統計學意義,其值分別為[OR0.51,95%CI(0.14,1.87)],[OR0.68,95%CI(0.26,1.73)]和[OR0.47,95%CI(0.04,5.36)];兩組均未發現血漿中皮質類固醇濃度降低.莫米松與安慰劑比較,鼻出血的危險性增加,但無統計學意義[OR157,95%CI(0.41,5.95)];發生鼻炎、頭痛的危險性降低,但無統計學意義.其值分別為OR0.33,95%CI(0.01,8.22)和OR0.33,95%CI(0.01,8.22),兩組均未發生血漿中皮質類固醇濃度降低.
結論　從此系統評價來看,成人、兒童鼻腔局部長期應用類固醇藥物是安全的.所納入的文獻中有2篇研究質量高,有4篇研究質量中等,有1篇存在高度偏倚.文獻存在選擇性偏倚和測量性偏倚.加之文獻僅來自中、英文兩種語種,文獻樣本含量較小,故需擴大樣本含量,增加高質量文獻,并納入除中、英文外的其它語種文獻,以增強論證強度.

引用本文： 孟照莉,白玫,梁傳余. 鼻腔局部應用類固醇藥物治療慢性鼻竇炎/鼻息肉和變應性鼻炎的安全性系統評價. 中國循證醫學雜志, 2004, 04(8): 563-569. doi: 復制

1.	［1］Gu ZY, Gu RJ. Pharmacotherapy for allergic rhinitis [J].Chin J Otorhinolaryngol, 2000; 35 ( 1 ): 73 - 75.
2.	顧之燕,顧瑞金.變應性鼻炎的藥物療法[J].中華耳鼻咽喉科雜志,2000;35(1):73～75.
3.	［2］Kanai N, Denburg J, Jardana M. Nasal poly inflammation:effect of topical nasal steroid[J]. Am J Respir Crit Care Med,1994; 150(4): 1 094-1 100.
4.	［3］Juni P, Altman DG, Egger M. Assessing the quality of controlled clinical trials[J]. BMJ, 2001; 323:42-46.
5.	［4］Grossman J, Banov C, Bronsky EA, Nathan RA, Pearman D, Winder JA, Rather PH, Mendelson L, Findlay SR, Kral KM, Field EA, Rogenes PR. Fluticasone propionate aqueous nasal spray is safe and effective for children with seasonal allergic rhinitis[J]. Pediatrics, 1993; 92(4): 594 -599.
6.	［5］Mostafa BE. Fluticasone propionate is associated with severe infection after endoscopic polypectomy [J]. Arch Otolaryngol Head Neck Surg, 1996; 122:729-731.
7.	［6］Skoner DP, Rachelefsky GS, Meltzer EO, Chervinsky P, Morris RM, SeltzerJM, Storms WW, Wood RS. Detection of growth suppression in children during treatment with intranasal beclomethasone dipropionate [J]. Pediatrics, 2000;105(2): 23 -29.
8.	［7］Schenkel EJ, Skoner DP, Bronsky EA, Miller SD, Pearlman DS, Rookin A, Rosen JP, Ruff ME, Vanderwalker ML,Wanderer A, Damaraju CV, Nolop KB, Mesarina-Wicki B. Absence of growth retardation in children with perennial allergic rhinitis after one year of treatment with mometasone furoate aqueous nasal spray[J]. Pediatrics, 2000; 105(2): 16 -22.
9.	［8］Baroody FM, Cheng CC, Moylan B, deTineo M, Haney L,Reed KD, Cook CK, Westlund RE, Sengupla E, Corey JP,Togias A, Naclerio RM. Absence of nasal mucosal atrophy with fluticasone aqueous nasal spray[J]. Arch Otolaryngol Head Surg, 2001; 127:193-199.
10.	［9］Juniper EF , Kline PA, R amsdale EH, Hargreave FE. Comparison of the efficacy and side effects of aqueous steroid nasal spray (budesonide) and allergic rhinoconjunctivitis [J]. Allergy Clin Immunol, 1990; 85(3): 606 -611.
11.	［10］Gastpar H, Acerich R, Petzold U, Dorow P, Enmann H,Gering R, Kochy HP, Philipp A, Renz W, Wendenburg G. Intranasal treament of perennial allergic rhinitis[J]. Drug Res,1993; 43(1): 475-479.
12.	［11］Kolssek JM, Peloquin L, Friedman WH. Diffuse nasal polyposis: postoperative long-term results after endoscopic sinus surgery and fronta lirrigation [J]. Otolarygnol Head Neck Surg,1997; 117(4): 355 -361.
13.	［12］Zhang L. The effect and mechanism of glucocorticosteroid for cure nasal polyp[J ]. Medical Journal Abroad (Otorhinolaryngology), 2000; 24(2): 73 -77.
14.	張羅.糖皮質激素治療鼻息肉的療效和機理[J].國外醫學耳鼻咽喉科學分冊,2000;24(2):73～77.

1. ［1］Gu ZY, Gu RJ. Pharmacotherapy for allergic rhinitis [J].Chin J Otorhinolaryngol, 2000; 35 ( 1 ): 73 - 75.
2. 顧之燕,顧瑞金.變應性鼻炎的藥物療法[J].中華耳鼻咽喉科雜志,2000;35(1):73～75.
3. ［2］Kanai N, Denburg J, Jardana M. Nasal poly inflammation:effect of topical nasal steroid[J]. Am J Respir Crit Care Med,1994; 150(4): 1 094-1 100.
4. ［3］Juni P, Altman DG, Egger M. Assessing the quality of controlled clinical trials[J]. BMJ, 2001; 323:42-46.
5. ［4］Grossman J, Banov C, Bronsky EA, Nathan RA, Pearman D, Winder JA, Rather PH, Mendelson L, Findlay SR, Kral KM, Field EA, Rogenes PR. Fluticasone propionate aqueous nasal spray is safe and effective for children with seasonal allergic rhinitis[J]. Pediatrics, 1993; 92(4): 594 -599.
6. ［5］Mostafa BE. Fluticasone propionate is associated with severe infection after endoscopic polypectomy [J]. Arch Otolaryngol Head Neck Surg, 1996; 122:729-731.
7. ［6］Skoner DP, Rachelefsky GS, Meltzer EO, Chervinsky P, Morris RM, SeltzerJM, Storms WW, Wood RS. Detection of growth suppression in children during treatment with intranasal beclomethasone dipropionate [J]. Pediatrics, 2000;105(2): 23 -29.
8. ［7］Schenkel EJ, Skoner DP, Bronsky EA, Miller SD, Pearlman DS, Rookin A, Rosen JP, Ruff ME, Vanderwalker ML,Wanderer A, Damaraju CV, Nolop KB, Mesarina-Wicki B. Absence of growth retardation in children with perennial allergic rhinitis after one year of treatment with mometasone furoate aqueous nasal spray[J]. Pediatrics, 2000; 105(2): 16 -22.
9. ［8］Baroody FM, Cheng CC, Moylan B, deTineo M, Haney L,Reed KD, Cook CK, Westlund RE, Sengupla E, Corey JP,Togias A, Naclerio RM. Absence of nasal mucosal atrophy with fluticasone aqueous nasal spray[J]. Arch Otolaryngol Head Surg, 2001; 127:193-199.
10. ［9］Juniper EF , Kline PA, R amsdale EH, Hargreave FE. Comparison of the efficacy and side effects of aqueous steroid nasal spray (budesonide) and allergic rhinoconjunctivitis [J]. Allergy Clin Immunol, 1990; 85(3): 606 -611.
11. ［10］Gastpar H, Acerich R, Petzold U, Dorow P, Enmann H,Gering R, Kochy HP, Philipp A, Renz W, Wendenburg G. Intranasal treament of perennial allergic rhinitis[J]. Drug Res,1993; 43(1): 475-479.
12. ［11］Kolssek JM, Peloquin L, Friedman WH. Diffuse nasal polyposis: postoperative long-term results after endoscopic sinus surgery and fronta lirrigation [J]. Otolarygnol Head Neck Surg,1997; 117(4): 355 -361.
13. ［12］Zhang L. The effect and mechanism of glucocorticosteroid for cure nasal polyp[J ]. Medical Journal Abroad (Otorhinolaryngology), 2000; 24(2): 73 -77.
14. 張羅.糖皮質激素治療鼻息肉的療效和機理[J].國外醫學耳鼻咽喉科學分冊,2000;24(2):73～77.

《中國循證醫學雜志》

鼻腔局部應用類固醇藥物治療慢性鼻竇炎/鼻息肉和變應性鼻炎的安全性系統評價

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

Content

《中國循證醫學雜志》

鼻腔局部應用類固醇藥物治療慢性鼻竇炎/鼻息肉和變應性鼻炎的安全性系統評價

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

Content

摘要全文圖表視頻參考文獻施引文獻補充材料