鼻用糖皮质激素与抗组胺药对合并过敏性鼻炎的哮喘患者哮喘控制的影响：一项系统评价

文献信息

中文摘要

目的： 确定在确诊过敏性鼻炎（AR）与哮喘共病的成人中，使用鼻内糖皮质激素（INCS）或抗组胺药治疗过敏性鼻炎是否能改善哮喘结局。
数据来源： 对PubMed、MEDLINE（Ovid）、Embase和Google Scholar进行了从数据库建库至2025年5月的系统检索。此外，还对纳入研究的参考文献列表进行了补充手工检索。
研究选择： 十项试验符合纳入标准（n=12,924名参与者；持续时间：2-24周）。七项研究纳入哮喘症状评分的荟萃分析，而其他结局因报告不完整或异质性较大而进行叙述性综合。
结果： 两种干预均与哮喘症状控制的统计学显著改善相关。合并效应支持两个治疗组（标准化均数差（SMD）=-0.55；95% CI：-0.67至-0.43），亚组分析显示抗组胺药具有一致的获益（SMD=-0.51），而INCS的效应在数值上更大，但差异无统计学意义（SMD=-0.87）。然而，没有纳入的试验直接比较INCS与抗组胺药，因此该比较仍为间接比较。关于肺功能、急救药物使用、支气管高反应性和急性加重的证据有限，且大多数试验缺乏可提取的数据。证据确定性水平（GRADE）显示症状结局为中等，而所有其他领域为低至极低。
结论： 在患有哮喘的成人中，使用抗组胺药或INCS对AR进行辅助治疗，在哮喘症状控制方面显示出具有临床相关性的改善。然而，证据基础受到样本量小、随访期短和报告欠佳的制约。需要更多采用标准化哮喘指标的、有足够把握度的临床试验，以明确长期获益和成本效益。

英文摘要

OBJECTIVE: To determine whether treating allergic rhinitis (AR) with intranasal corticosteroids (INCS) or antihistamines improves asthma outcomes in adults with confirmed AR-asthma comorbidity.Data Sources: A systematic search of PubMed, MEDLINE (Ovid), Embase, and Google Scholar was conducted from the inception of the databases to May 2025. In addition, a supplementary hand search of the reference lists of included studies was conducted.Study Selections: Ten trials met the inclusion criteria (n = 12,924 participants; duration: 2-24 weeks). Seven studies contributed to the meta-analysis of asthma symptom scores, while other outcomes were narratively synthesized owing to incomplete or heterogeneous reporting.
RESULTS: Both interventions were associated with statistically significant improvement in asthma symptom control. The pooled effect favoured both treatment arms (standardized mean difference (SMD) = -0.55; 95% CI: - 0.67 to - 0.43), with subgroup analysis showing a consistent benefit from antihistamines (SMD = - 0.51) and a numerically larger, though nonsignificantly different, effect for INCS (SMD = - 0.87). However, no included trial compared INCS with antihistamines directly, so this comparison remains indirect. Evidence was limited for lung function, rescue medication use, bronchial hyperresponsiveness, and exacerbations, and most trials lacked data that could be extracted. Certainty level (GRADE) shows moderate for symptom outcomes and low to very low for all other domains.
CONCLUSION: Adjunctive treatment of AR with antihistamines or INCS, shows a clinically relevant improvement in asthma symptom control among adults with asthma. However, the evidence base is constrained by small sample sizes, short follow-up periods, and suboptimal reporting. More Powered clinical trials using standardized asthma metrics are needed to clarify the long-term benefit and cost-effectiveness.