中国儿科领域随机对照试验报告质量横断面调查

摘要目的评估CONSORT声明自1997年引入中国以来,中国儿科杂志发表RCT的报告质量是否得到提高。方法手工检索中国大陆被中国科学引文数据库（CSCD）收录的6种国内儿科杂志（《中华儿科杂志》、《中华小儿外科杂志》、《中国当代儿科杂志》、《中国实用儿科杂志》、《中国循证儿科杂志》和《临床儿科杂志》）,检索时间均为创刊至2010年12月。对照CONSORT声明的评价条目清单,设计标准的资料提取表格,评估纳入文献的报告质量,使用SPSS 18.0软件进行统计分析。结果619篇RCT文献进入分析。1997至2010年与1997年前发表的RCT相比,其在文题、摘要、引言、受试者招募、基线资料和辅助分析等方面的报告质量有一定的改善（P<0.05）,但在方法学的报告方面存在报告不充分或不准确的问题,如确定样本量的方法（0.6% vs 1.1%）、随机序列产生的方法（3.2% vs 7.6%）、分配隐藏（0 vs 1.1%）、盲法（0 vs 2.6%）等。进一步对稿约中要求CONSORT声明的《中国循证儿科杂志》发表的9篇RCT进行评估,其CONSORT条目符合率均高于其他儿科杂志,特别在方法学的报告方面,如确定样本量的方法、随机序列产生的方法、分配隐藏和盲法等。结论总体而言,CONSORT声明的引入并没有使中国儿科领域RCT的报告质量从根本上提高。在稿约中要求CONSORT声明的杂志可显著提高RCT的报告质量。     

Efficacy of a home-made spacer with acute exacerbation of bronchial asthma : A randomized controlled trial

Metered dose inhaler (MDI) with spacer is the preferred method for administration of aerosolized medications in pediatric asthma. The expense of commercial spacers limits their use and indigenous alternatives have therefore been developed. Information on the clinical efficacy of home-made spacers is limited. This study was conducted to compare the efficacy of a valve-less home-made spacer with a commercial spacer in delivering salbutamolvia MDI in acute asthma. Asthmatic children aged 5–15 years who presented with an acute exacerbation to the pediatric chest clinic of a tertiary care hospital were enrolled in a single blinded randomized parallel group study. The study patients received 10 puffs of salbutamol (100(igJ puff)via MDI-home-made spacer or MDI-commercial spacer. Pre and post inhalation measurements of peak expiratory flow rate (PEFR), oxygen saturation (SaO2), respiratory rate (RR), pulse rate (PR) were made and compared. Sixty children were enrolled in the study, 31 were administered salbutamolvia the home-made spacer and 29via the commercial spacer. The median increase in PEFR was similar in both the groups (20.8% vs22.2%, p=0.4), clinical improvement being satisfactory in all patients. The valve-less home-made spacer is equally efficacious and cheaper than the commercial spacer in administering bronchodilators in acute exacerbations of asthma. Further studies on the efficacy of home-made spacer in delivery of inhaled steroids are needed.     

槐杞黄颗粒辅助治疗儿童哮喘的随机对照多中心临床研究

目的：比较全球哮喘防治创议(The Global Initiative for Asthma,GINA)方案与 GINA 方案联合口服槐杞黄颗粒治疗哮喘患儿的临床疗效和安全性。方法采用随机、多中心平行对照临床试验方法。共收集1128例哮喘患儿,随机分为两组。观察组患儿采用 GINA 方案联合口服槐杞黄颗粒治疗,GINA 方案治疗组患儿按 GINA 方案治疗。分别于用药后的第1个月、3个月、6个月进行临床评价及 C-ACT 评分。临床评价指标为上呼吸道感染次数、支气管炎和肺炎发生次数、喘息发作次数、应用急救药次数、因喘息住院次数。比较两组的药物不良反应发生情况。结果用药后的第1个月、3个月、6个月,观察组较 GINA方案治疗组上呼吸道感染发生次数、支气管炎和肺炎发生次数及喘息发作次数均明显减少(P ＜0.05),C-ACT 评分均明显升高(P ＜0.05)。与药物相关的不良反应16例(轻度腹泻),其中观察组7例(1.15％), GINA 方案治疗组9例(1.73％),组间差异无统计学意义(P ＞0.05)。结论 GINA 方案联合口服槐杞黄颗粒治疗哮喘患儿,能明显减少其呼吸道感染及喘息发作的次数,可显著改善临床疗效,更好地达到哮喘控制的目标,且安全性好。     

阻断乙型肝炎病毒宫内传播的随机对照研究

目的 最近10多年的研究表明，用乙肝疫苗主被动联合免疫能阻断母婴间乙肝病毒（HBV）传播，保护效果达到70％－90％，而宫内已感染HBV是生后免疫接种失败的主要原因，我们研究用乙肝免疫球蛋白（HBIG）多次产前注射，观察阻断HBV宫内传播的效果。方法 980例携带HBsAg孕妇随机分成两组，一组孕妇产前3个月（妊娠28周起）每4周肌注HBIG 200IU－400IU，直至临产，称HBIG组；另一组不注射为对照，称对照组。所有对象和其所生孩子出生时即采外周血，检测HBsAg、HBeAg，部分测HBV DNA，所有新生儿随访1年。结果 496例新生儿为对照组母亲所生，生后仅接种乙肝疫苗和HBIG；491例新生儿为HBIG组母亲所生，生后同样给予主被动联合免疫。结果显示对照组婴儿的宫内感染率为难4．3％；而HBIG组婴儿的宫内感染率为5．7％（x^2＝20．11，P＜0．001），宫内感染HBV的高危因素是母亲呈HBsAg、HBeAg双阳性或HBV DNA阳性。结论 研究提出产前多次肌注HBIG可有效减少HBV的宫内传播，未发现任何副作用。     

Efficacy and safety of a new apple-flavoured oral rehydration solution in children with acute gastroenteritis: a double-blind randomized controlled trial

Aim: To assess the efficacy and safety of a new oral rehydration solution (ORS) with improved flavour in the management of children with acute gastroenteritis (AGE). Methods: Children 4 to 48 months of age with AGE (≥3 loose or watery stools per day for >1 but <5 days) with mild‐to‐moderate dehydration (3% to 9% loss of body weight) according to the World Health Organization criteria randomly received regular hypotonic ORS (Na 60 mmol/L, glucose 78 mmol/L) or the same hypotonic ORS with an apple taste. Results: Of the 147 children randomized, 130 (88.4%) were available for intention‐to‐treat analysis. The proportion of children with the resolution of signs of dehydration in the experimental group compared with the control group was similar at 24 h (49/63 vs. 57/67, respectively, p = 0.28). There were also no significant differences in adequate weight gain (p = 0.48) and urine production at 24 h (p = 0.95) between groups. There were no differences between groups in any of the secondary outcome measures, including ORS intake. No adverse events were observed in the study groups. Conclusions: In an outpatient setting, there was no difference in efficacy between the study products. Both ORSs were equally effective and may be used interchangeably.     

Postnatal peer counselling on exclusive breastfeeding of low-birthweight infants: a randomized, controlled trial

AIM: Exclusive breastfeeding increases survival and optimizes growth of low-birthweight (LBW) infants. If supported, mothers can overcome the unique difficulties associated with breastfeeding from birth to 6 mo. We tested the efficacy of postnatal peer counselling among first-time mothers that aimed to increase exclusive breastfeeding of term LBW infants. METHODS: In a Manila hospital, 204 mothers were randomized into three groups. Two intervention groups receiving home-based counselling visits, one by counsellors trained in breastfeeding counselling (n=68), the other by counsellors trained in general childcare (n=67), were compared with a control group of mothers (n=69) who did not receive counselling. RESULTS: Eighty-eight per cent of the participating pairs completed the trial. At 6 mo, 44% of the breastfeeding counselled mothers, 7% childcare-counselled mothers and none of the mothers in the control group were exclusively breastfeeding. More mothers in the breastfeeding counselled group than in the other groups were still breastfeeding at 6 mo. Twenty-four infants who were exclusively breastfed for 6 mo did not have any diarrhoea. All groups had improved mean weight-for-age Z-scores at 6 mo. CONCLUSION: This study has provided fundamental evidence of successful intervention to achieve 6 mo of exclusive breastfeeding among term LBW infants. By improving health outcomes, enhanced breastfeeding offers a distinct possibility of disrupting the intergenerational cycle of undernourished women giving birth to LBW infants.