阿奇霉素辅助治疗儿童毛细支气管炎有效性的系统回顾与Meta分析

Clinical effect of azithromycin adjuvant therapy in children with bronchiolitis: a systematic review and Meta analysis

摘要:

目的 系统评价阿奇霉素（AZM）辅助治疗儿童毛细支气管炎的有效性。方法 采用RevMan 5.3软件，对截止2019年2月17日国内外发表的关于AZM用于辅助治疗毛细支气管炎的临床随机对照试验进行Meta分析。结果 共纳入14篇文献，干预组667例，对照组651例。合并效应量结果显示，AZM辅助治疗不能缩短毛细支气管炎患儿的住院时间（MD=-0.29，95% CI：-0.62~0.04，P=0.08）及用氧时间（MD=-0.33，95% CI：-0.73~0.07，P=0.10）；可以缩短患儿喘息（MD=-1.00，95% CI：-1.72~-0.28，P=0.007）及咳嗽缓解时间（MD=-0.48，95% CI：-0.67~-0.29，P < 0.00001）。菌群分析结果提示，AZM能有效减少患儿鼻咽部肺炎链球菌（OR=0.24，95% CI：0.11~0.54，P=0.0006）、嗜血杆菌属（OR=0.28，95% CI：0.14~0.55，P=0.0002）和卡他莫拉菌（OR=0.21，95% CI：0.11~0.40，P < 0.00001）的检出率。结论 AZM辅助治疗儿童毛细支气管炎一定程度上有助于缩短患儿咳嗽及喘息缓解时间，但对住院及用氧时间的影响不显著。

Abstract:

Objective To systematically evaluate the clinical effect of azithromycin (AZM) adjuvant therapy in children with bronchiolitis. Methods Related databases were searched for randomized controlled trials (RCTs) on AZM adjuvant therapy in children with bronchiolitis published up to February 17, 2019. RevMan 5.3 was used to perform the Meta analysis. Results A total of 14 RCTs were included, with 667 children in the intervention group and 651 in the control group. The pooled effect size showed that in the children with bronchiolitis, AZM adjuvant therapy did not shorten the length of hospital stay (MD=-0.29, 95%CI:-0.62 to 0.04, P=0.08) or oxygen supply time (MD=-0.33, 95%CI:-0.73 to 0.07, P=0.10), while it significantly shortened the time to the relief of wheezing (MD=-1.00, 95%CI:-1.72 to -0.28, P=0.007) and cough (MD=-0.48, 95%CI:-0.67 to -0.29, P < 0.00001). The analysis of bacterial colonization revealed that AZM therapy significantly reduced the detection rates of Streptococcus pneumoniae (OR=0.24, 95%CI:0.11-0.54, P=0.0006), Haemophilus (OR=0.28, 95%CI:0.14-0.55, P=0.0002), and Moraxella catarrhalis (OR=0.21, 95%CI:0.11-0.40, P < 0.00001) in the nasopharyngeal region. Conclusions AZM adjuvant therapy can reduce the time to the relief of wheezing and cough in children with bronchiolitis, but it has no marked effect on the length of hospital stay and oxygen supply time.