皮质类固醇对急性鼻窦炎无效


  【24drs.com】根据一篇新研究,全身性皮质类固醇单一治疗对急性鼻窦炎病患者似乎没有帮助。
  
  荷兰Utrecht大学医学中心Julius 健康科学与初级照护中心的Roderick P. Venekamp博士等人的研究结果在线登载于8月7日加拿大医学协会期刊。
  
  Venekamp博士等人结论表示,我们发现,对于临床诊断无并发症之急性鼻窦炎患者,全身性皮质类固醇单一治疗并无临床相关效果。
  
  根据研究者指出,皮质类固醇用于症状控制的情况大幅增加,但是支持使用的证据并无定论。
  
  这次的随机控制试验试图要评估全身性皮质类固醇单一疗法的效果,研究对象是174名临床诊断无并发症之急性鼻窦炎患者(治疗组有88人,安慰剂组有86人)。
  
  病患被随机指派接受每天30 mg prednisolone或安慰剂,为期7天,之后完成14天的症状日记;初级结果测量是,第7天时,脸部疼痛或压力缓解的病患比率。
  
  第7天时,prednisolone组有62.5% (55/88)病患符合初级结果,安慰剂组有55.8% (48/86)。(绝对风险差异6.7%;95%信心区间,-7.9%至21.2%;相对风险,1.12;95%信心区间,0.87 - 1.44)。
  
  症状包括流鼻涕、后鼻腔分泌物、鼻塞、咳嗽、脸部疼痛,两组的缓解比率相同,此外,健康相关生活质量和副作用也相差无几。
  
  作者们建议,后续研究应聚焦在哪里类型的病患才可能从鼻腔内或全身性皮质类固醇治疗获益。
  
  他们指出,同时,我们认为,对于大多数临床诊断急性鼻窦炎患者,并无适当理由使用皮质类固醇,而主张的是对症疗法。
  
  作者们指出,研究限制包括,在随机分组之前使用临床诊断而非更准确的X光评估;不过,临床实务上并未使用X光评估。他们指出,纳入根据X光评估的病患,将因而大幅降低研究结果的一般性。
  
  另一项研究限制是,强度不足以侦测各小组之间的显著统计差异,此外,这篇研究评估了全身性的皮质类固醇而非鼻腔内剂型,后者在部分过敏性鼻窦炎病患显示有效。
  
  资料来源:http://www.24drs.com/professional/list/content.asp?x_idno=6906&x_classno=0&x_chkdelpoint=Y
  

Corticosteroids Show No Benefit in Acute Sinusitis

By Emma Hitt, PhD
Medscape Medical News

August 7, 2012 — Systemic corticosteroid monotherapy appears to have no benefit in patients with acute rhinosinusitis, according to new research.

Roderick P. Venekamp, MD, PhD, from the Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, the Netherlands, and colleagues published their findings online August 7 in the Canadian Medical Association Journal.

"We found no clinically relevant effect of systemic corticosteroid monotherapy among patients with clinically diagnosed, uncomplicated acute rhinosinusitis," Dr. Venekamp and colleagues conclude.

According to the researchers, corticosteroids are being "increasingly used for symptom control," but evidence supporting their use is inconclusive.

The current randomized controlled trial sought to evaluate systemic corticosteroid monotherapy in 174 patients (88 in the treatment group and 86 in the placebo group) with clinically diagnosed, uncomplicated acute rhinosinusitis.

Patients were randomly assigned to receive prednisolone 30 mg/day or placebo for 7 days and then completed a symptom diary for 14 days. The primary outcome measure was the proportion of patients with resolution of facial pain or pressure on day 7.

The primary outcome was met by 62.5% (55/88) of the patients in the prednisolone group and 55.8% (48/86) of the patients in the placebo group by day 7 (absolute risk difference, 6.7%; 95% confidence interval, ?7.9% to 21.2%; relative risk, 1.12; 95% confidence interval, 0.87 - 1.44).

Symptoms, including runny nose, postnasal discharge, nasal congestion, cough, and facial pain, resolved at the same rate in both groups. In addition, health-related quality of life and adverse events were comparable.

The authors suggest that future studies focus on identifying specific subgroups of patients who may benefit from intranasal or systemic corticosteroid treatment.

"In the meantime, we feel that there is no rationale for the use of corticosteroids in the broad population of patients with clinically diagnosed acute rhinosinusitis and instead advocate symptomatic treatment," they add.

The authors note that study limitations included the fact that they used a clinical diagnosis rather than a potentially more accurate radiologic assessment before randomization; however, they note that radiologic assessment is not used in clinical practice. "Inclusion of patients based on radiologic assessment would therefore have strongly reduced the generalizability of our findings," they add.

Another limitation was that the study was underpowered to detect statistically significant differences among subgroups. In addition, the study evaluated systemic, not intranasal, corticosteroids, which may demonstrate efficacy in allergic rhinitis, which was present in some patients.

The study was supported by a grant from the Netherlands Organisation for Health Research and Development One author has been an advisory board member for Pfizer Netherlands and has received a grant from Pfizer Netherlands for studies on pneumonia. One author has participated in workshops and educational activities on otitis media organized by GlaxoSmithKline and received a grant from GlaxoSmithKline for a study on the microbiology of otitis media. One author has received consultancy fees and a grant for studies on pneumonia from Pfizer Netherlands. One author has been an advisory board member for Chiesi Pharmaceuticals BV and has participated in educational activities on a smoking cessation strategy for family physicians organized by Pfizer Netherlands. Dr. Venekamp has disclosed no relevant financial relationships.

CMAJ. Published online August 7, 2012.

    
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