treiouh 2010-2-1 12:48
類固醇可能有效緩解急性咽喉炎疼痛
作者：Laurie Barclay, MD
出處：WebMD醫學新聞
January 15, 2010 — 根據一項發表於1/2月號家醫科學誌（Annals of Family Medicine）的系統性綜論，類固醇在緩解急性咽喉炎上作為輔助治療是有效的。
德國Goettingen大學的Katrin Korb醫師寫到，喉嚨疼痛病患一個主要的治療目標是緩解疼痛且減少吞嚥時的困難。類固醇的抗發炎作用在緩解因為發炎造成的疼痛上可能是有效的，且在其他種類的上呼吸道感染中已經有相關研究。因此，類固醇可能代表一個合乎病患需求的有效臨床治療選擇。
這項系統性綜論的目標在於綜合評估以皮質類固醇作為急性咽喉炎緩解疼痛輔助療法隨機分派研究（RCTs）效果的證據。在搜尋1966年至2008年12月的MEDLINE、EMBASE與Cochrane RCT系統性綜論資料庫後，由兩位審閱者評估每一篇搜尋到的文獻，並且綜合這些數據。
在找到的8篇RCT中，共收納了806位門診病患，其中5項研究收納成人病患，3項研究收納兒童病患。相較於安慰劑，使用類固醇（dexamethasone、betamethasone或prednisone）與疼痛緩解速度顯著較快、或完全止痛比例較高有關。雖然所有研究都容許使用acetaminophen或其他止痛藥物，並非所有研究都控制這些因子。研究沒有發現嚴重不良反應。
試驗作者們寫到，類固醇藥物可以有效地緩解急性咽喉炎疼痛。雖然沒有觀察到嚴重不良反應，但其所帶來的好處必須與可能的不良反應平衡。在緩解喉嚨疼痛上，這些藥物是安全且有效的非處方用藥。
這項系統性綜論的限制包括可能的發表誤差，偏向發現類固醇是有效的、可能的回溯誤差、以及收納研究先天上的限制。收納研究之間使用特定藥物、劑量、投予方法與預後評量都有所不同。
研究作者們的結論是，大部分病患同時併用抗生素；然而，降低一般良性上呼吸道感染處方抗生素是一個重要的公共衛生目標。我們因此建議進行更多研究來確認在未使用抗生素的情況下使用類固醇的好處，以及與非處方止痛藥物併用時，類固醇額外的好處。
Steroids May Effectively Relieve Pain of Acute Pharyngitis
By Laurie Barclay, MD
Medscape Medical News
January 15, 2010 — Steroids are effective as adjuvant therapy in relieving pain in acute pharyngitis, according to the results of a systematic review reported in the January/February issue of the Annals of Family Medicine.
"A major treatment goal for patients complaining of sore throat is to relieve pain and alleviate difficulties in swallowing," write Katrin Korb, MD, from the University of Goettingen in Germany, and colleagues. "The anti-inflammatory action of steroids might be effective to relieve symptoms caused by inflammation and has been studied in other upper respiratory tract infections. Steroids might, therefore, represent a useful clinical option to meet patients' needs."
The purpose of this review was to summarize evidence from randomized controlled trials (RCTs) that assessed the efficacy of adjuvant therapy with corticosteroids to relieve the pain of acute pharyngitis. After searching MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews for RCTs published between 1966 and December 2008, 2 reviewers evaluated the quality of each identified article and summarized the data.
Of 8 identified RCTs enrolling a total of 806 ambulatory patients, 5 enrolled adult patients and 3 enrolled children. Compared with placebo, steroid use (dexamethasone, betamethasone, or prednisone) was associated with statistically significant faster reduction of pain or complete pain relief in all identified RCTs. Most participants had been treated with antibiotics at least initially. Although use of acetaminophen or other analgesic medication was permitted in all studies, this factor was not always controlled. There were no serious adverse effects.
"Steroids are effective in relieving pain in acute pharyngitis," the study authors write. "Although no serious adverse effects were observed, the benefits have to be balanced with possible adverse drug effects. There are safe and effective over-the-counter medications to relieve throat pain."
Limitations of this systematic review include possible publication bias favoring studies finding steroids to be beneficial, possible recall bias, and limitations inherent in the included studies. Specific drugs used, dosing and administration, and outcome measures all varied among the included trials.
"Most patients received concomitant antibiotics; however, reducing the prescription of antibiotics for generally benign upper respiratory tract infection is a public health goal," the review authors conclude. "We therefore recommend further studies to establish both the safety of steroids without antibiotic coverage and the additional benefits of steroids when used with regular administration of over-the-counter analgesic medications."
Ann Fam Med. 2010;8:58-63.