本帖最後由 lsc0019 於 2009-8-2 20:56 編輯
作者：Laurie Barclay, MD
出處：WebMD醫學新聞
July 20, 2009 — 根據線上發表於7月8日Cochrane Database of Systematic Reviews的回顧結果，建議使用非類固醇消炎藥物(NSAIDs)於緩解一般感冒引起的不適與疼痛。
南韓首爾Kangdong Sacred心臟醫院的Soo Young Kim等人寫道，雖然NSAIDs被廣泛用於治療一般感冒相關的疼痛與發燒，並沒有系統性的回顧來分析NSAIDs用於一般感冒患者的效果。有一些證據認為，感冒症狀可能是激肽和前列腺素等發炎調節因子造成的結果，NSAIDs可以阻斷這些因子，而非直接導致病毒產生細胞病變。
此次系統性回顧的目標，是評估NSAIDs相較於安慰劑和其他治療對於一般感冒徵兆與症狀的效果，確認那些接受NSAIDs緩解感冒症狀之患者有無任何的副作用。
回顧者搜尋了控制試驗的Cochrane登記中心(The Cochrane Library 2009，第1版)，包括了急性呼吸道感染組之特定登記、1996年1月至2009年3月的MEDLINE、1980年1月至2009年3月的EMBASE、1982年1月至2009年3月的CINAHL、1938年1月至2009年3月的ProQuest Digital Dissertations、1958年1月至2009年3月的KoreaMed、以及1949年1月至2009年3月的KMbase。
納入回顧的規範為，NSAIDs用於成人或小孩治療一般感冒的隨機控制試驗(RCTs)。這些試驗細分為比較NSAIDs與安慰劑者，以及比較特定NSAIDs和其他NSAIDs者。回顧作者的其中4人摘錄並彙整所有有關NSAIDs效果的資料。這些包括頭痛和肌痛的止痛效果；鼻腔症狀、咳嗽、痰與打噴嚏等非止痛效果；以及副作用。
有9篇RCT符合納入規範，總共比較37組、1,064名一般感冒病患。其中有6篇比較NSAIDs與安慰劑，3篇比較特定NSAIDs和其他NSAIDs。根據統合分析的結果，以NSAIDs治療並未顯著降低整體症狀分數或縮短感冒期間。
不過，NSAID治療對頭痛、耳朵痛、肌肉與關節痛等的相關止痛效果有顯著幫助。雖然未能緩解喉嚨發炎，對於不舒服和寒顫有邊緣效益。
至於呼吸道症狀，打噴嚏有顯著改善，但是咳嗽和鼻腔分泌物沒有改善。NSAID治療組並未顯著增加副作用頻率。
回顧作者寫道，作者們建議使用NSAIDs緩解一般感冒引起的不適或疼痛。需要後續研究以探討NSAIDs 用於緩解咳嗽或鼻腔分泌物等症狀的效果。
此回顧的限制包括，納入之研究的方法學品質各異，主要是因為漏失隨機步驟的資訊。此外，回顧並未提及乙醯胺酚和NSAIDs的比較。
作者們結論表示，根據此回顧納入的資料，我們無法排除NSAIDs可有效降低咳嗽的理論。大型的NSAIDs用於感冒之研究試驗或許可以釐清此一關係。
回顧作者群宣告沒有相關財務關係。
Cochrane Database Syst Rev.線上發表於2009年7月8日。
NSAIDs Recommended for Relieving Discomfort, Pain Caused by the Common Cold
By Laurie Barclay, MD
Medscape Medical News
July 20, 2009 — Nonsteroidal anti-inflammatory drugs (NSAIDs) are recommended for relieving discomfort or pain caused by the common cold, according to the results of a review reported online in the July 8 issue of the Cochrane Database of Systematic Reviews.
"Although...NSAIDs have been widely used for the treatment of pain and fever associated with the common cold, there is no systematic review to assess the effects of NSAIDs in patients with the common cold," write Soo Young Kim, from Kangdong Sacred Heart Hospital in Seoul, South Korea, and colleagues. "There is some evidence that cold symptoms might be the result of inflammatory mediators such as kinins and prostaglandins, which can be blocked by NSAIDs, rather than the result of the direct cytopathic effects of viruses."
The goals of this systematic review were to evaluate the effects of NSAIDs vs placebo and other treatments on the signs and symptoms of the common cold and to identify any adverse effects of NSAIDs in patients receiving them for relief of common cold symptoms.
The reviewers searched the Cochrane Central Register of Controlled Trials (The Cochrane Library 2009, issue 1), which includes the Acute Respiratory Infections Group's Specialized Register, MEDLINE from January 1966 to March 2009, EMBASE from January 1980 to March 2009, CINAHL from January 1982 to March 2009, ProQuest Digital Dissertations from January 1938 to March 2009, KoreaMed from January 1958 to March 2009, and KMbase from January 1949 to March 2009.
Criteria for inclusion in the review were randomized controlled trials (RCTs) of NSAIDs for treatment of the common cold in adults or children. Trials were subdivided into those comparing NSAIDs vs placebo and those comparing specific NSAIDs vs other NSAIDs. Four of the review authors extracted and summarized data regarding global efficacies of NSAIDs. These included analgesic effects on headache and myalgia; nonanalgesic effects on nasal symptoms, cough, sputum, and sneezing; and adverse effects.
Selection criteria were met by 9 RCTs involving a total of 37 comparisons in a total of 1064 patients with the common cold. Of these, 6 compared NSAIDs vs placebo, and 3 compared specific NSAIDs vs other NSAIDs. Treatment with NSAIDs did not significantly reduce the total symptom score, or duration of colds, according to the results of a pooled analysis.
However, NSAID treatment was associated with significant benefits for outcomes related to analgesic effects on headache, ear pain, and muscle and joint pain. Although throat irritation was not relieved, there was a borderline benefit for malaise and mixed results for chills.
With respiratory tract symptoms, the sneezing score significantly improved, but there was no improvement in scores for cough and nasal discharge. The NSAID treatment groups had no apparent evidence of increased frequency of adverse effects.
"The authors recommend NSAIDs for relieving discomfort or pain caused by the common cold," the review authors write. "Further research is needed to investigate the effect of NSAIDs in relieving respiratory symptoms such as cough and nasal discharge."
Limitations of this review include mixed methodologic quality of the included studies, largely because of missing information regarding randomization procedures. In addition, the review did not address the comparison of acetaminophen vs NSAIDs.
"We were unable to exclude the theory that NSAIDs are effective in reducing cough based upon the data included in this review," the authors conclude. “A large trial to study NSAIDs in colds may make this relationship clearer."
The review authors have disclosed no relevant financial relationships.
Cochrane Database Syst Rev. Published online July 8, 2009. |
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