大环内酯类抗生素对慢性阻塞性肺疾病患者急性加重频率影响的Meta分析

目的 系统评价长期口服低剂量的大环内酯类抗生素预防稳定期慢性阻塞性肺疾病患者急性加重的临床疗效和安全性。方法 计算机检索Pubmed、Embase、Web of science、VIP、CNKI、万方等中英文数据库，查找相关随机试验对照研究，按纳入排除标准由两名评价员独立选择试验和评价质量后，提取有效数据采用Revmen5.2软件进行Meta分析。结果 试验组急性加重频率低于对照组（RR=0.6，95% CI：0.37~0.96）］。按照用药时间不同进行亚组分析，服用大环内酯类抗生素6个月的COPD患者实验组的急性加重频率低于对照组（RR=0.61，95% CI：0.4~0.94）；服用大环内酯类抗生素3、12个月的COPD患者实验组和对照组比较，差异均无统计学意义（P>0.05）；长期服用大环内酯类抗生素并不能够改善患者的肺功能；长期服用大环内酯类抗生素是否能够改善SGRQ评分有待更多研究；治疗期间药物不良反应以胃肠道为主，且实验组和对照组比较差异无统计学意义（P>0.05）。结论 长期口服低剂量的大环内酯类抗生素可降低稳定期COPD患者急性加重频率，但并不能改善患者肺功能。

Meta analysis on Effectiveness and Safety of Macrolides in Prevention of COPD Exacerbation

Objective To systematically evaluate the effectiveness and safety of long-term oral administration of low dose macrolides in the prevention of COPD exacerbation. Methods The literatures concerning randomized controlled trials(RCTs) of COPD were searched in Pubmed,Embase,Web of science,Chinese Science and Technology Journal Full-text Database(VIP),Chinese National Knowledge Infrastructure(CNKI) and Wanfang. The quality assessment and data extraction for RCTs were conducted by two reviewers independently according to the inclusion and exclusion criteria.Meta-analyses were conducted with the Cochrane Collaboration''s RevMan 5. 2 software. Results In all trials, the results indicated that the frequency of acute exacerbation in the macrolide treatment group was decreased compared with the control group(RR=0.6,95% CI:0.37-0.96).Subgroup analysis was performed according to the different time of administration.The frequency of acute exacerbation treated with macrolides was significantly decreased in patients who were given drugs for 6 months (RR=0.61, 95% CI:0.4-0.94) but not in patients who were given drugs for 3 or 12 months.Long term use of macrolides can not improve patient''s lung function,but whether can improve the SGRQ score still need more researchs.In addition, the macrolides treatment had no side effects except for a few and mild gastrointestinal adverse effects,and there was no significant difference between the experimental group and the control group in most researchs. Conclusion Long term oral administration of low doses of macrolides can reduce the acute exacerbation frequency of COPD, but can not improve patient''s lung fuction.