Efficacy of a short course of parent-initiated oral prednisolone for viral wheeze in children aged 1-5 years: randomised controlled trial
Efficacy of a short course of parent-initiated oral prednisolone for viral wheeze in children aged 1-5 years: randomised controlled trial
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DOI：
10.1016/s0140-6736(03)14685-5
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发表时间：
2003-11-01
期刊：
影响因子：
168.9
通讯作者：
Grigg, J
中科院分区：
文献类型：
--
作者：
Oommen, A;Lambert, PC;Grigg, J
背景 由病毒性感冒引发的阵发性喘息常见于 1 至 5 岁的儿童（学龄前病毒性喘息）。大多数受影响的儿童在 6 岁时都没有症状。喘息的持续存在与高于平均水平的全身嗜酸性粒细胞启动相关。建议在出现学龄前病毒性哮鸣的第一个迹象时，建议由父母开始口服泼尼松龙。然而，这种治疗策略的证据是相互矛盾的。因此，我们的目的是评估短期口服泼尼松龙治疗学龄前病毒性喘息的疗效，并对全身嗜酸性粒细胞启动进行分层。方法根据血清嗜酸性粒细胞阳离子蛋白和嗜酸性粒细胞蛋白 X 的含量，将因病毒性喘息入院的 1-5 岁儿童分配到高启动或低启动层，并随机接受父母启动的泼尼松龙（每天 20 毫克） 5 天）或下一集的安慰剂。主要结果是 7 天平均白天和夜间呼吸道症状评分，通过治疗组之间的平均差异进行分析。结果 108 名儿童被随机分配到安慰剂组，109 名儿童被随机分配到泼尼松龙组。 153 名再次出现病毒性哮鸣的儿童中，有 120 名（78%）的结果数据可用，其中 51 名接受泼尼松龙治疗，69 名接受安慰剂治疗。治疗组之间的平均白天（平均值差异 -0.01 [-0.22 至 0.20]）和夜间（0.10 [-0.12 至 0.32]）呼吸道症状评分和入院需要没有差异。在高引发 (n = 59) 和低引发 (n = 61) 层中，治疗组之间的主要结局没有差异。 解释 即使对于嗜酸性粒细胞引发高于平均水平的儿童，家长启动的短期口服泼尼松龙治疗对于 1-5 岁儿童的病毒性哮鸣也没有明显的益处。
Background Episodic wheeze triggered by viral colds is common in children aged between 1 and 5 years (preschool viral wheeze). Most affected children are asymptomatic by age 6 years. Persistence of wheeze is associated with above-average systemic eosinophil priming. Use of parental-initiated oral prednisolone is recommended at the first sign of preschool viral wheeze. However, evidence for this treatment strategy is conflicting. We therefore aimed to assess the efficacy of a short course of oral prednisolone for preschool viral wheeze, with stratification for systemic eosinophil priming.Methods Children aged 1-5 years admitted to hospital with viral wheeze were allocated to either a high-primed or low-primed stratum according to amounts of serum eosinophil cationic protein and eosinophil protein X, and randomised to parent-initiated prednisolone (20 mg one daily for 5 days) or placebo for the next episode. The primary outcomes were the 7-day mean daytime and night-time respiratory symptom scores, which were analysed by mean differences between treatment groups.Findings 108 children were randomised to placebo and 109 to prednisolone. Outcome data were available for 120 (78%) of 153 children who had a further episode of viral wheeze, of whom 51 received prednisolone and 69 placebo. Mean daytime (difference in means -0.01 [-0.22 to 0.20]) and night-time (0.10 [-0.12 to 0.32]) respiratory symptom scores and need for hospital admission did not differ between treatment groups. Within the high-primed (n=59) and low-primed (n=61) strata there was no difference in primary outcome between treatment groups.Interpretation There is no clear benefit of a short course of parent-initiated oral prednisolone for viral wheeze in children aged 1-5 years even in those with above-average eosinophil priming.