上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 论著（临床研究） • 上一篇    下一篇

基于中国人群吸入激素相关口腔念珠菌病防治的系统评价

程挺，程齐俭，屠瑾，万欢英   

  1. 上海交通大学 医学院附属瑞金医院北院， 上海 201801
  • 出版日期:2015-11-28 发布日期:2016-01-13
  • 通讯作者: 屠瑾, 电子信箱: 18217097640@126.com。
  • 作者简介:程挺 (1988—)， 男， 住院医师， 博士; 电子信箱: chengting425@126.com。
  • 基金资助:

    上海申康医院发展中心慢性病综合防治项目（SHDC12012305）; 上海交通大学医学院附属瑞金医院北院研究基金（2015ZY04）

Systemic assessment of prevention and treatment of oral candidiasis relevant to inhaled corticosteroids based on Chinese population

CHENG Ting, CHENG Qi-jian, TU Jin, WAN Huan-ying   

  1. Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai 201801, China
  • Online:2015-11-28 Published:2016-01-13
  • Supported by:

    Chronic Disease Prevention and Treatment Program of the Shanghai Hospital Development Center, China, SHDC12012305; Research Foundation of Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine, 2015ZY04

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摘要：

目的  系统总结基于中国人群的吸入激素相关口腔念珠菌病防治的临床研究。方法  在万方数据库、中国学术期刊全文数据库（CNKI）、维普数据库、Medline数据库和Cochrane数据库中，检索建库以来，基于中国人群的吸入激素相关口腔念珠菌病防治的临床研究。对同类研究结果，以meta分析进行合并。结果  共纳入19篇文献。与不积极预防相比，积极预防可显著降低吸入激素者出现口腔念珠菌病的风险，危险比（RR）为0.221（P<0.001）。与生理盐水或白开水相比，用各种药物或碳酸氢钠进行漱口或口腔护理可显著降低吸入激素时口腔念珠菌病的发生率及口咽部念珠菌检出率，发病率RR为0.180（P<0.001），检出率RR为0.157（P<0.001）。在口腔念珠菌病的治疗中，用碳酸氢钠或酮康唑复方制剂漱口和口腔护理，喷洒复方维生素B12溶液均有效。结论  为减少口腔念珠菌病的发生，每次吸入激素后，应立即用碳酸氢钠溶液漱口2~3次或行口腔护理。酌情加用制霉菌素溶液涂布。条件允许时，医务人员应督导患者完成漱口。

关键词: 吸入激素, 口腔念珠菌病, 不良反应, 漱口, 口腔护理, 碳酸氢钠, 制霉菌素

Abstract:

Objective  To systemically summarize clinical studies on prevention and treatment of oral candidiasis relevant to inhaled corticosteroids (ICS) based on Chinese population. Methods  Clinical studies on prevention and treatment of oral candidiasis relevant to ICS based on Chinese population were retrieved from Wanfang periodical databases, China National Knowledge Infrastructure, VIP Journal Integration Platform, Medline and Cochrane databases. The meta analysis was performed to combine studies of the same kind. Results  A total of 19 papers were included. Compared with conservative methods, active prevention significantly decreased the incidence of oral candidiasis of the patients who inhaled corticosteroids and the relative risk (RR) was 0.221 (P<0.001). Compared with normal saline or boiled water, performing mouth wash or oral care with sodium bicarbonate or drugs significantly decreased the incidence of oral candidiasis and the detection rate of Candida albicans in oropharynx for the patients who inhaled corticosteroids. The RR of the incidence was 0.180 (P<0.001) and the RR of the detection rate was 0.157 (P<0.001). Mouth washing or oral care with sodium bicarbonate solution, compound preparation of ketoconazole, or compound vitamin B12 solution spray were all effective for treating patients with oral candidiasis relevant to ICS. Conclusion  Patients should wash their mouths 2-3 times with sodium bicarbonate solution or perform oral care immediately after inhalation of corticosteroids to reduce the incidence of oral candidiasis. The nystatin solution can be used if necessary. Medical staff should supervise patients to wash their months if possible.

Key words: inhaled corticosteroids, oral candidiasis, adverse effect, mouth wash, oral care, sodium bicarbonate, nystatin