3～18岁儿童变应性哮喘患者的舌下免疫治疗疗效荟萃分析
2008/06/06
已有研究证实舌下免疫疗法对鼻炎患者的疗效和安全性，但其对哮喘的疗效还有待评估。为验证该疗法对儿童变应性哮喘的疗效，Martin Penagos等人进行的随机双盲对照实验收集了2006年5月31日以前的数据，回顾了73篇文章。并用随机性效应模型对原始数据结果（例如：症状的评分和治疗药物的应用）进行标准平均差计算以及RevMan4.2.8统计软件进行分析。结果发现其中9篇（发表于1990年后）符合选择标准。共对441名患者进行了最终评估和分析。其中232名患者接受了舌下免疫疗法，其余的209名患者作为对照。
分析结果表明由于不同的评分系统造成了相关异质性。重新统计的结果为：应用舌下免疫疗法明显减少了症状(p = 0.02)和药物治疗(p = 0.007)的用量。即在治疗儿童变应性哮喘中，标准的舌下免疫疗法较对照组能明显减少症状评分和药物治疗的用量。
（于娜 中国医科大学附属第一医院呼吸内科 110001 摘择）
(Chest. 2008 Mar;133(3):599-609)
Metaanalysis of the efficacy of sublingual immunotherapy in the treatment of allergic asthma in pediatric patients, 3 to 18 years of age.
Penagos M, Passalacqua G, Compalati E, Baena-Cagnani CE, Orozco S, Pedroza A, Canonica GW.
BACKGROUND: Recent studies have documented the efficacy and safety of sublingual immunotherapy (SLIT) in patients with rhinitis, but the value of this treatment in those with asthma is still debated. We evaluated the efficacy of SLIT in the treatment of allergic asthma in children by a metaanalysis of randomized, double-blind, and placebo-controlled (DBPC) clinical trials.
METHODS: Electronic databases were searched up to May 31, 2006, for randomized DBPC trials assessing SLIT in pediatric cases of asthma. Effects on primary outcomes (ie, symptom scores and concomitant use of rescue medication) were calculated with standardized mean differences (SMDs) using the random-effects model. We performed the metaanalysis using a statistical software package (RevMan, 4.2.8; The Cochrane Collaboration; Oxford, UK), and we followed the recommendations of the Cochrane Collaboration and the Quality of Reporting of Metaanalyses guidelines.
RESULTS: Seventy-three articles were identified and reviewed. Nine studies, all published after 1990, fulfilled the selection criteria. A total of 441 patients had a final assessment and were included in the analysis. Two hundred thirty-two patients received SLIT, and 209 patients received placebo. The results of the present analysis demonstrated a relevant heterogeneity due to widely differing scoring systems. Overall, there was a significant reduction in both symptoms (SMD - 1.14; 95% confidence interval [CI], - 2.10 to - 0.18; p = 0.02) and medication use (SMD, - 1.63; 95% CI, - 2.83 to - 0.44; p = 0.007) following SLIT.
CONCLUSION: SLIT with standardized extracts reduces both symptom scores and rescue medication use in children with allergic asthma compared with placebo.
Key Words: asthma • children • efficacy • metaanalysis • randomized controlled trials • sublingual immunotherapy
（Chest. 2008 Mar;133(3):599-609. Epub 2007 Oct 20. Links）
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目前减少尘螨暴露的物理和/或化学方法，并不能有效改善过敏性哮喘患者呼吸功能，减少哮喘发作及用药
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