鼻用糖皮质激素在儿童气道炎症中的应用：从药代动力学和证据到优化临床实践。

文献信息

中文摘要

鼻用糖皮质激素（INS）因其强效的局部抗炎作用和良好的安全性，被广泛推荐为儿童上气道疾病的一线治疗。本叙述性综述评估了当前关于INS在患有过敏性鼻炎（AR）、腺样体肥大（ADH）、阻塞性睡眠呼吸暂停（OSA）或睡眠呼吸障碍（SDB）、分泌性中耳炎（OME）和鼻窦炎（RS）的儿童中的药理学特性、临床疗效和安全性的证据。对PubMed、EMBASE和Cochrane数据库（2015-2025年）进行的结构化文献检索确定了评估适应证、疗效结局和不良事件的随机对照试验、观察性研究、系统综述和荟萃分析。证据一致支持INS是儿童AR最有效的药物治疗，可显著改善症状评分和生活质量。在ADH和轻度OSA/SDB中，INS可能减轻鼻塞并缩小腺样体体积，从而可能降低手术干预的需求。OME的数据不一致，不普遍推荐常规使用。在急性和慢性RS中，INS显示出益处，尤其是在过敏性炎症占主导时。不同药物的药代动力学差异影响安全性。较新的分子如丙酸氟替卡松、糠酸氟替卡松和糠酸莫米松具有低全身生物利用度和高受体亲和力，可最大限度地减少下丘脑-垂体-肾上腺轴抑制。局部不良反应通常轻微，与安慰剂相当。鼻出血是公认的局部不良反应，尽管儿科数据未显示与安慰剂相比有显著增加。现有数据表明，使用推荐剂量时对生长速度的影响极小且无临床意义。总体而言，INS仍是AR治疗的基石，在适当使用时具有确证的疗效和良好的安全性。也有支持性和具有临床意义的证据表明其可用于选定的ADH儿童，尽管现有证据异质性较大。相比之下，INS在OME、OSA/SDB和儿童CRS中的证据仍然有限或不一致，目前不支持仅针对这些儿童上气道疾病常规使用，尤其是在不伴有鼻过敏性炎症的情况下。

英文摘要

Intranasal corticosteroids (INS) are widely recommended as first-line therapy for pediatric upper airway disorders due to their potent local anti-inflammatory effects and favorable safety profile. This narrative review evaluates current evidence regarding the pharmacologic properties, clinical efficacy, and safety of INS in children with allergic rhinitis (AR), adenoid hypertrophy (ADH), obstructive sleep apnea (OSA) or sleep-disordered breathing (SDB), otitis media with effusion (OME), and rhinosinusitis (RS). A structured literature search of PubMed, EMBASE, and Cochrane databases (2015-2025) identified randomized controlled trials, observational studies, systematic reviews, and meta-analyses assessing indications, efficacy outcomes, and adverse events. Evidence consistently supports INS as the most effective pharmacologic therapy for pediatric AR, with significant improvements in symptom scores and quality of life. In ADH and mild OSA/SDB, INS may reduce nasal obstruction and decrease adenoid size, potentially lowering the need for surgical intervention. Data for OME are inconsistent, and routine use is not universally recommended. In acute and chronic RS, INS demonstrates benefit, particularly when allergic inflammation predominates. Pharmacokinetic differences among agents influence safety. Newer molecules such as fluticasone propionate, fluticasone furoate, and mometasone furoate exhibit low systemic bioavailability and high receptor affinity, minimizing hypothalamic-pituitary-adrenal axis suppression. Local adverse effects are generally mild and comparable to placebo. Epistaxis is a recognized local adverse effect, although pediatric data do not demonstrate a significant increase compared with placebo. Available data suggest minimal, clinically insignificant effects on growth velocity when recommended doses are used. Overall, INS remain a cornerstone of AR therapy, with well-established efficacy and a favorable safety profile when appropriately used. There is also supportive and clinically meaningful evidence for their use in selected children with ADH, although the available evidence is heterogeneous. In contrast, evidence for INS in OME, OSA/SDB, and pediatric CRS remains limited or inconsistent and does not currently support their routine use solely for these pediatric upper airway conditions, particularly in the absence of concomitant nasal allergic inflammation.