| Objective: To evaluate the efficacy and safety of long-term low-dose azithromycin in the treatment of stable bronchiectasis by meta analysis of randomized controlled trials.And to analyze the effects of dose,course and bronchodilator on the curative effect.Methods: The retrieval method was computer retrieval combined with manual retrieval.The computer searches Cochrane Library,Pubmed,Embase,Web of Science,CBM disc,CNKI,VIP,Wangfang Data databases.The retrieval was from the establishment of the database to September 2019.The cross-retrieval between various databases is for comprehensive retrieval as much as possible.Manual-search included all kinds of related reports in medical core journals.The literatures were screened according to the retrieval strategy,inclusion and exclusion criteria.And designed table was used to extract the feature information that was finally included in the literature.The included literatures were analyzed by meta with Review manager 5.3 statistical software.The mean difference(MD)was selected for the combined effect of continuous data,and the elative risk(RR)was selected for the combined effect of discrete data.The heterogeneity was judged by x2 test,and then the fixed or random effect model was selected for analysis.The primary outcomes were the frequency of acute aggravation,the change of FEV1 and the adverse effects rate.In the subgroup,the effects of different doses,courses of treatment and bronchodilators were discussed.Results:Results of included literature: A total of 29 articles were included,with 2469 subjects.The age was from 18 to 81 years old and the average age was about 55.And male accounted for 69.1%.There were 14 studies with azithromycin dose <1750 mg per week,13 studies were 1750 mg/week and 2 studies were >1750 mg/week.There were 3 studies with azithromycin course were <6 months,22 studies were 6 months and 4 studies were >6 months.There were 6 studies were used of bronchodilators,and the other 23 studies were none of bronchodilators.Results of Meta analysis:Primary outcome measures:(1)The frequency of acute exacerbation during treatment in the azithromycin intervention group was lower than that in the control group,which was statistically significant [MD=-0.86,95%CI(-0.96,-0.75)];The change of FEV1(2)of pulmonary function in azithromycin intervention group was better than that in control group,which was statistically significant [MD=0.15,95%CI(0.10,0.20)];(3)There was no significant difference in the adverse effects rate between azithromycin group and the control group [RR=-0.95,95% CI(0.80,1.12)].At the same time,there were no obvious bias and meta analysis were stable which by Stata 12.0 software.Secondary outcome measures:(1)It was more helpful for bronchiectasis to reduce the frequency of acute exacerbation with azithromycin in 1750 mg/week compared with <1750mg/week,the difference was statistically significant [MD=-0.87,95%CI(-1.18,-0.57)] vs [MD=-0.77,95%CI(-0.81,-0.73)].(2)The change of FEV1 of pulmonary function in the intervention group treated with azithromycin for 6 months was better that <6 months group,which was statistically significant [MD=0.16,95%CI(0.13,0.19)] vs [MD=0.02,95%CI(0.00,0.20)].(3)Whether long-term low-dose azithromycin combined with bronchodilator was beneficial to reduce the frequency of acute exacerbation [MD=-0.80,95%CI(-0.89,-0.71)] vs [MD=-0.89,95%CI(-1.03,-0.74)].(4)Whether long-term low-dose azithromycin combined with bronchodilator was beneficial to improve FEV1 [MD=0.16,95%CI(0.11,0.22)] vs [MD=0.14,95% CI(0.07,0.21)].Conclusion: The long-term low-dose azithromycin treatment is beneficial to reduce the frequency of acute aggravation,improve the FEV1 and have good tolerance. |
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