奥马珠单抗治疗难治性变应性哮喘效果的Meta分析

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摘要目的系统评价奥马珠单抗治疗难治性哮喘的效果。方法计算机检索PubMed、Web of Science、Embase、Cochrane Library、ScienceDirect数据库，各数据库检索时间均从建库到2017年11月。由2名研究者进行文献筛选、资料提取及文献质量评价，采用RevMan 5.3进行Meta分析。结果共纳入12篇临床对照试验。在激素量恒定期和激素量减少期，奥马珠单抗较对照组可明显提高哮喘患者生活质量（RR = 1.56，95%CI：1.32～1.85，P ＜ 0.000 01；RR = 1.90，95%CI：1.45～2.49，P ＜ 0.000 01），同时增加研究者对治疗效果总体评级为“优”或“良”的人数（RR = 1.36，95%CI：1.25～1.49，P ＜ 0.000 01；RR = 1.48，95%CI：1.36～1.61，P ＜ 0.000 01）。奥马珠单抗可减少激素量恒定期难治性哮喘急性重度恶化风险（RR = 0.51，95%CI：0.41～0.64，P ＜ 0.000 01）。结论在哮喘指南常规治疗基础上加用奥马珠单抗，可提高哮喘患者生活质量，改善症状，减少哮喘重度急性发作风险。

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	牟姗张薇江德鹏

关键词 ：难治性哮喘, 奥马珠单抗, Meta分析, 哮喘生活质量问卷调查评分, 研究者对治疗效果总体评级, 急性重度恶化

Abstract：Objective To evaluate the effectiveness of Omalizumab in patients with refractory allergic asthma. Methods The databases including PubMed, Web of Science, Embase, Cochrane Library, and ScienceDirect were searched by computer, and the retrieval time of each database was from the database establishment to November 2017. Then 2 reviewers screened studies, extracted data, and evaluated the quality of included randomized controlled trials, and Meta-analyses were conducted with RevMan 5.3. Results A total of 12 clinical randomized controlled trials were included. Compared with placebo, Omalizumab treatment was associated with an improved asthma-related quality of life at the end of the stable (RR = 1.56, 95%CI: 1.32-1.85, P ＜ 0.000 01) and steroid dose reduction phases (RR = 1.90, 95%CI: 1.45-2.49, P ＜ 0.000 01). Meanwhile, compared with placebo, Omalizumab therapy showed a significantly increased number of patients with investigator global evaluation of therapy effective rated as excellent or good at the end of both phases (RR = 1.36, 95%CI: 1.25-1.49, P ＜ 0.000 01; RR = 1.48, 95%CI: 1.36-1.61, P ＜ 0.000 01). Besides, Omalizumab reduced the number of patients with severe exacerbations during stable-steroid phase (RR = 0.51, 95%CI: 0.41-0.64, P ＜ 0.000 01). Conclusion The addition of Omalizumab to standard therapy in patients with refractory allergic asthma can improve asthma related quality of life, relieve symptoms and reduce severe asthma exacerbations.

Key words： Refractory allergic asthma Omalizumab Meta analysis Questionnaire of asthma quality of life in adults Investigator global evaluation of therapy effectiveness Severe exacerbations

基金资助:国家自然科学基金资助项目（81650003）。

通讯作者: 江德鹏（1977-），男，副主任医师，副教授，硕士研究生导师，主要从事慢性气道炎症疾病发病机制及治疗的研究工作。

引用本文:

牟姗张薇江德鹏. 奥马珠单抗治疗难治性变应性哮喘效果的Meta分析[J]. 中国医药导报, 2019, 16(10): 75-79,99.
MOU Shan ZHANG Wei JIANG Depeng. Effectiveness of Omalizumab for patients with refractory allergic asthma: a Meta analysis of randomized controlled studies. 中国医药导报, 2019, 16(10): 75-79,99.

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http://www.yiyaodaobao.com.cn/CN/ 或 http://www.yiyaodaobao.com.cn/CN/Y2019/V16/I10/75

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