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山东大学学报 (医学版) ›› 2019, Vol. 57 ›› Issue (11): 27-33.doi: 10.6040/j.issn.1671-7554.0.2019.484

• • 上一篇    

克拉霉素辅助治疗哮喘疗效及安全性的Meta分析

王海霞1,李一章1,白晨晓1,姜迪1,王丽雯1,陈欧1,2   

  1. 1. 山东大学护理学院, 山东 济南 250012;2.山东大学第二医院小儿内科, 山东 济南 250033
  • 发布日期:2022-09-27
  • 通讯作者: 陈欧. E-mail:chenou@sdu.edu.cn
  • 基金资助:
    国家自然科学基金资助项目(81400072);山东省重点研发项目(2019GSF108198);山东大学人文社科青年团队项目(IFYT1811,IFYT18036)

A Meta-analysis of the efficacy and safety of clarithromycin in adjuvant treatment of asthma

WANG Haixia1, LI Yizhang1, BAI Chenxiao1, JIANG Di1, WANG Liwen1, CHEN Ou1,2   

  1. 1. Nursing School of Shandong University, Jinan 250012, Shandong, China;
    2. Departments of Pediatrics, The School Hospital of Shandong University, Jinan 250033, Shandong, China
  • Published:2022-09-27

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摘要： 目的 系统评价克拉霉素辅助治疗哮喘的疗效及安全性。 方法 检索中国知网(CNKI)、万方、重庆维普(VIP)、中国生物医学文献数据库、Pubmed、Cochrane Library、EMbase 和Web of Science数据库,检索时间均从建库至2019年3月31日,根据Cochrane风险偏倚评价工具［1］对文献质量评价。所有研究对象分为克拉霉素组和对照组(未使用克拉霉素),结局指标为肺功能指标: FEV1%(1s用力呼气容积),FEV1/FVC(用力肺活量),FEV1(L)和PEFR(呼气峰值流速)(L/min);哮喘控制问卷(ACQ)评分和ACT(哮喘控制测试)评分,应用RevMan5.5软件进行Meta分析。 结果 最终纳入11篇临床随机对照试验(RCT):英文4篇,中文7篇。Meta结果显示:(1)克拉霉素组与对照组肺功能比较FEV1% 和FEV1(L)差异无统计学意义(P>0.05),FEV1/FVC和PEFR(L/min)差异有统计学意义(P<0.05);(2)克拉霉素组与对照组ACQ评分比较差异有统计学意义(P<0.05);(3)克拉霉素组与对照组ACT评分比较差异无统计学意义(P>0.05);(4) 2篇文献报道不良反应(急性哮喘加重、胃肠道反应和呼吸道感染)。 结论 克拉霉素一定程度上可改善哮喘的肺功能［FEV1/FVC%和PEFR(L/min)］和哮喘控制情况(ACQ评分),也存在不良反应,如急性哮喘加重、胃肠道反应和呼吸道感染。

关键词: 克拉霉素, 哮喘, 随机对照试验, Meta分析

Abstract: Objective To systematically evaluate the efficacy and safety of clarithromycin in the adjuvant treatment of asthma. Methods Randomized controlled trials(RCTs)on the efficacy and safety of clarithromycin in treating asthma were searched in CNKI, Wanfang, VIP, China Biomedical Literature Database, Pubmed, Cochrane Library, EMbase and Web of Science from the establishment of databases to March 31, 2019. The quality of the literature was evaluated with Cochrane bias risk assessment tool. The subjects were divided into clarithromycin group and control group. The outcome indicators were forced expiratory volume in one second(FEV1%), forced vital capacity(FEV1/FVC), FEV1(L), peak expiratory flow rate(PEFR)(L/min), asthma control questionnaire(ACQ)score and asthma control test(ACT)score. Meta-analysis was performed using RevMan 5.5 software. Results Altogether 11 RCTs were enrolled, including 4 in English and 7 in Chinese. Meta results showed: (1) There was no significant difference in FEV1% and FEV1(L)between the clarithromycin group and control group(P>0.05), while there was significant difference in FEV1/FVC and PEFR(L/min)(P<0.05). (2) There was significant difference in ACQ score between the two groups 山 东 大 学 学 报 (医 学 版)57卷11期 -王海霞,等.克拉霉素辅助治疗哮喘疗效及安全性的Meta分析 \=-(P<0.05). (3) There was no significant difference in ACT score between the two groups(P>0.05). (4) Only 2 RCTs reported adverse reactions such as exacerbation of acute asthma, gastrointestinal reactions and respiratory infection. Conclusion Clarithromycin can improve the lung function ［FEV1/FVC% and PEFR(L/min)］ and asthma control(ACQ score). It also may cause some adverse reactions, such as exacerbation of acute asthma, gastrointestinal reactions and respiratory infection.

Key words: Clarithromycin, Asthma, Randomized controlled trials, Meta-analysis

中图分类号: 

  • R725.6
[1] 曾宪涛, 任学群. 应用STATA做Meta分析[M]. 2版. 北京: 中国协和医科大学出版社, 2017: 17-18.
[2] Webley WC, Hahn DL. Infection-mediated asthma: etiology, mechanisms and treatment options, with focus on Chlamydia pneumoniae and macrolides[J]. Respir Res, 2017, 18(1): 98.
[3] 张清玲. 2018全球哮喘防治倡议哮喘指南解读[J]. 中国实用内科杂志, 2018, 38(8): 739-741. ZHANG Qingling. Interpretation of asthma guidelines in the 2018 global initiative for asthma management and prevention[J]. Chinese Journal of Practical Internal Medicine, 2018, 38(8): 739-741.
[4] 张茂荣, 龚财惠, 涂金伟, 等. 阿奇霉素辅助治疗支气管哮喘疗效和安全性的Meta分析[J]. 儿科药学杂志, 2019, 25(4): 6-11. ZHANG Maorong, GONG Caihui, TU Jinwei, et al. Meta-analysis of efficacy and safety of azithromycin in the adjuvant treatment of bronchial asthma in children[J]. Journal of Pediatric Pharmacy, 2019, 25(4): 6-11.
[5] Wong EH, Porter JD, Edwards MR, et al. The role of macrolides in asthma: current evidence and future directions[J]. Lancet Respir Med, 2014, 2(8): 657-670.
[6] Hara K, Kondo M, Tsuji M, et al. Clarithromycin suppresses IL-13-induced goblet cell metaplasia via the TMEM16A-dependent pathway in guinea pig airway epithelial cells[J]. Respir Investig, 2019, 57(1): 79-88.
[7] Komiya K, Ohta S, Arima K, et al. Clarithromycin attenuates IL-13-induced periostin production in human lung fibroblasts[J]. Respir Res, 2017, 18(1): 37.
[8] 刘春, 邓述恺. 克拉霉素对烟雾暴露哮喘小鼠肺组织中组蛋白去乙酰化酶2及糖皮质激素受体α表达的影响[J]. 中国抗生素杂志, 2017, 42(2): 154-159. LIU Chun, DENG Shukai. The effects of clarithromycin on histone deacetylase 2 and glucocorticoid receptor in lung tissues of smoke exposed asthmatic mice[J]. Chinese Journal of Antibiotics, 2017, 42(2): 154-159.
[9] 潘德锋, 佘菊香, 胡春艳. 克拉霉素对反复喘息急性加重期患儿TNF-α、IL-1β和IL-10产生的影响[J]. 中国妇幼保健, 2012, 27(14): 2133-2135. PAN Defeng, SHE Juxiang, HU Chunyan. Effect of Clarithromycin on TNF-α, IL-1 and IL-10 production in children with acute exacerbation of recurrent wheezing[J]. Maternal and Child Health Care of China, 2012, 27(14): 2133-2135.
[10] 旷文君, 刘毅, 尚思异. 克拉霉素对哮喘儿童肺功能及IgE水平的影响[J]. 中南医学科学杂志, 2011, 39(3): 324-325, 328.
[11] Amayasu H, Yoshida S, Ebana S, et al. Clarithromycin suppresses bronchial hyperresponsiveness associated with eosinophilic inflammation in patients with asthma[J]. Ann Allergy Asthma Immunol, 2000, 84(6): 594-598.
[12] Kostadima E, Tsiodras S, Alexopoulos EI, et al. Clarithromycin reduces the severity of bronchial hyperresponsiveness in patients with asthma[J]. Eur Respir J, 2004, 23(5): 714-717.
[13] Kostadima E, Tsiodras S, Alexopoulos EI, et al. Clarithromycin reduces the severity of bronchial hyperresponsiveness in patients with asthma[J]. Eur Respir J, 2004, 23(5): 714-717.
[14] Sutherland ER, King TS, Icitovic N, et al. A trial of clarithromycin for the treatment of suboptimally controlled asthma[J]. J Allergy Clin Immunol, 2010, 126(4): 747-753.
[15] 胡志雄, 周海英, 张熙, 等. 克拉霉素联合沙美特罗/氟替卡松治疗支气管哮喘的随机对照研究[J]. 中国临床医学, 2010, 17(4): 495-498. HU Zhixiong, ZHOU Haiying, ZHANG Xi, et al. A randomized comparative trial of clarithromycin combined regimens containing salmeterol/fluticasone for treatment of bronchial asthma[J]. Chinese Journal of Clinical Medicine, 2010, 17(4): 495-498.
[16] 张郁, 乔福斌, 任丽霞, 等. 小剂量克拉霉素治疗支气管哮喘疗效观察[J]. 临床军医杂志, 2010, 38(6): 960-961. ZHANG Yu, QIAO Fubin, REN Lixia, et al. Therapeutic effects of low dose clarithromycin on asthma[J]. Clinical Journal of Medical Officer, 2010, 38(6): 960-961.
[17] 王毅, 张淑立, 曲彦. 克拉霉素治疗非嗜酸粒细胞型难治性哮喘的疗效分析[J]. 临床肺科杂志, 2012, 17(11): 1948-1951. WANG Yi, ZHANG Shuli, QU Yan. Effect of clarithromycin on Non-eosinophilic refractory asthma[J]. Journal of Clinical pulmonary Medicine, 2012, 17(11): 1948-1951.
[18] 周旭东. 克拉霉素联合沙美特罗/氟替卡松治疗支气管哮喘的疗效比较[J]. 中国现代药物应用, 2012, 6(8): 88-89.
[19] 匡庆贵, 付印强, 陈顼, 等. 克拉霉素对儿童咳嗽变异性哮喘气道炎症的影响及疗效分析[J]. 临床肺科杂志, 2015, 20(6): 1095-1098, 1099. KUANG Qinggui, FU Yinqiang, CHEN Xu, et al. Influence and efficacy analysis of clarithromycin on children with cough variant asthma airway inflammation[J]. J Clin Pulm Med, 2015, 20(6): 1095-1098, 1099.
[20] 刘东辉, 刘立虎. 克拉霉素联合沙美特罗/氟替卡松治疗支气管哮喘的临床探讨[J]. 中外医疗, 2015, 34(2): 10-11. LIU Donghui, LIU Lihu. Clinical observation on the effect of clarithromycin combined with salme-terol/fluticasone in the treatment of bronchial asthma[J]. China Foreign Medical Treatment, 2015, 34(2): 10-11.
[21] 刘毅, 颜又新, 高燕. 克拉霉素联合沙美特罗/氟替卡松对支气管哮喘患者的疗效研究[J]. 当代医学, 2018, 24(16): 136-137. LIU Yi, YAN Youxin, GAO Yan. Efficacy of clarithromycin combined with salmeterol/fluticasone in patients with bronchial asthma[J]. Contemporary Medicine, 2018, 24(16): 136-137.
[22] Wan KS, Liu YC, Huang CS,et al. Effects of low-dose clarithromycin added to fluticasone on inflammatory markers and pulmonary function among children with asthma: A randomized clinical trial[J]. Allergy Rhinol(Providence), 2016,7(3): 131-134.
[23] Gotfried MH, Jung R, Messick CR, et al. Effects of six-week clarithromycin therapy in corticosteroid-dependent asthma: A randomized, double-blind, placebo-controlled pilot study[J]. Curr Ther Res Clin Exp, 2004, 65(1): 1-12.
[24] 张郁, 乔福斌, 任丽霞, 等. 克拉霉素联合小剂量舒利迭治疗支气管哮喘114例[J]. 中国药业, 2011, 20(3): 74-75.
[25] 曾宪涛, 任学群. 应用STATA做Meta分析[M]. 2版. 北京: 中国协和医科大学出版社, 2017: 31-33.
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