Efficacy and safety of local triamcinolone combined with conventional interventional therapy in treatment of benign airway stenosis: a meta-analysis_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

HE Jie ^1,2 , YU Mi ^1,2 , LI Xiaoyan ^1,2 , ZHANG Wei ^1,2 ,  SUN Jian ^1,2

1. Clinical Medical College of Chengdu Medical College, Chengdu, Sichuan 610500, P. R. China;
2. Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan 610500, P. R. China;

Corresponding?author：

SUN Jian, Email: 157110097@qq.com

Keywords：

Triamcinolone; Local injection; Local spraying; Benign airway stenosis; Meta-analysis

DOI：

10.7507/1671-6205.201908088

Video：

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Objective To evaluate the efficacy and safety of local triamcinolone combined with conventional interventional therapy in the treatment of benign airway stenosis. Methods PubMed, Cochrane Library, EMbase, Web of science, wanfang, VIP and China National Knowledge Infrastructure were searched by computer between the establishment of the database and August, 2019, and all literatures on the local treatment of benign airway stenosis using triamcinolone combined with conventional interventional therapy were searched. According to inclusion and exclusion criteria, 2 researchers screened the literatures and performed the data extraction and methodological quality evaluation. Meta-analysis was performed with Revman5.2 and Stata software. Results In total, nine randomized controlled trials were included in this meta-analysis, including 449 patients with airway stenosis. The total result showed that in the comparison of short-term efficacy, there were no statistically significant differences in breathability score (SMD=–0.16, 95%CI –0.45 - 0.13, P=0.27), airway diameter (SMD=0.14, 95%CI –0.13 - 0.41, P=0.30), and cross-sectional stenosis rate (SMD=–0.01, 95%CI –0.36 - 0.34, P=0.96) between the treatment group and the control group. In the comparison of long-term efficacy, the breathability score (SMD=–2.53, 95%CI –3.78 - –1.28, P<0.05), airway diameter (SMD=1.31, 95%CI 0.83 - 1.78, P<0.05), cross-sectional stenosis rate (SMD=2.58, 95%CI: 2.11~3.08, P<0.05), and FEV₁(SMD=0.42, 95%CI 0.13 - 0.70, P=0.004) of patients in the treatment group were all better than those in the control group. But in terms of adverse reactions, the incidence of bleeding in the airway between two groups was similar (RR=2.00, 95%CI 0.88 - 4.52, P=0.10), other adverse reactions such as blood glucose and plasma cortisol levels were mild, which can be relieved symptomatically. Conclusion Current evidence suggests that topical triamcinolone combined with conventional interventional therapy for benign airway stenosis has a better long-term clinical efficacy with fewer adverse reactions and better overall patient tolerance, which has clinical application value

Citation： HE Jie, YU Mi, LI Xiaoyan, ZHANG Wei, SUN Jian. Efficacy and safety of local triamcinolone combined with conventional interventional therapy in treatment of benign airway stenosis: a meta-analysis. Chinese Journal of Respiratory and Critical Care Medicine, 2021, 20(10): 726-733. doi: 10.7507/1671-6205.201908088 Copy

1.	Xiong XF, Xu L, Fan LL, et al. Long-term follow-up of self-expandable metallic stents in benign tracheobronchial stenosis: a retrospective study. BMC Pulm Med, 2019, 19(1): 33.
2.	Fortin M, Lacasse Y, Elharrar X, et al. Safety and efficacy of a fully covered self-expandable metallic stent in benign airway stenosis. Respiration, 2017, 93(6): 430-435.
3.	Kniese CM, Musani AI. Interventional pulmonology: a focused review for primary care physicians. Med Clin North Am, 2019, 103(3): 399-412.
4.	Michaud G. Review of recent important papers in interventional pulmonology. Semin Thorac Cardiovasc Surg, 2018, 30(2): 212-214.
5.	Mondoni M, Radovanovic D, Sotgiu G, et al. Interventional pulmonology techniques in elderly patients with comorbidities. Eur J Intern Med, 2019, 59: 14-20.
6.	Khan HA, Sahibzada MN, Paracha MM. Comparison of the efficacy of intralesional bleomycin versus intralesional triamcinolone acetonide in the treatment of keloids. Dermatol Ther, 2019, 32(5): e13036.
7.	陳愉, 伍惠儀, 李時悅, 等. 局部注射曲安奈德結合常規介入方法治療難治性良性中央氣道狹窄療效及安全性的初步探討. 中華結核和呼吸雜志, 2012, 35(6): 415-418.
8.	李志東, 陳思宇, 肖誼, 等. 氣管鏡下介入高壓球囊擴張聯合局部注射激素治療氣道狹窄的臨床研究. 中國藥物經濟學, 2014, 9(S1): 404-405.
9.	胡鑫, 張會云, 邊南南, 等. 第二代ALK抑制劑治療ALK⁺非小細胞肺癌有效性單組率的Meta分析. 中國循證醫學雜志, 2018, 18(9): 918-923.
10.	周子青, 蘇柱泉, 唐純麗, 等. 局部噴灑曲安奈德聯合球囊擴張治療良性中央氣道狹窄療效研究. 新醫學, 2016, 47(11): 742-746.
11.	肖陽寶, 羅莉, 羅林紫, 等. 局部注射曲安奈德聯合常規介入方法治療結核性支氣管瘢痕狹窄. 當代醫學, 2018, 24(22): 35-37.
12.	蔡向敬, 侯玉蓮, 段月庭, 等. 支氣管鏡下球囊高壓擴張聯合曲安奈德局部注射治療結核性支氣管狹窄的效果觀察. 河北醫學, 2017, 23(12): 1956-1958.
13.	雷小婷, 孟泳, 包愛華, 等. 氣管鏡下球囊擴張聯合曲安奈德局部注射治療氣道狹窄的遠期療效. 中國實用醫刊, 2019, 46(4): 11-14.
14.	馬建永, 李春. 曲安奈德結合常規介入治療難治性良性中央氣道狹窄療效及安全性評價. 中國初級衛生保健, 2013, 27(4): 118-119.
15.	齊亞麗, 顧玉海, 李龍昱, 等. 局部注射曲安奈德結合常規介入方法治療難治生良性中央氣道狹窄療效及安全性的初步探討. 黑龍江醫藥, 2016, 29(4): 699-700.
16.	龍發, 周愛蓮, 李俊華, 等. 電子支氣管鏡下球囊高壓擴張加曲安奈德注射治療結核性支氣管狹窄的臨床研究. 臨床內科雜志, 2015, 32(11): 782-783.
17.	Guibert N, Didier A, Moreno B, et al. Treatment of complex airway stenoses using patient-specific 3 D-engineered stents: a proof-of-concept study. Thorax, 2019, 74(8): 810-813.
18.	Fiorelli A, Poggi C, Ardo NP, et al. Flow-volume curve analysis for predicting recurrence after endoscopic dilation of airway stenosis. Ann Thorac Surg, 2019, 108(1): 203-210.
19.	Rezende MU, Andrusaitis FR, Silva RT, et al. Joint lavage followed by viscosupplementation and triamcinolone in patients with severe haemophilic arthropathy: objective functional results. Haemophilia, 2017, 23(2): e105-e115.
20.	Elavarasi A, Goyal V, Singh MB, et al. Is triamcinolone an easy and efficient way to treat meralgia paresthetica? A Cohort Study. Ann Indian Acad Neurol, 2019, 22(3): 308-310.
21.	McSwiney TJ, Power B, Murphy CC, et al. Safety and efficacy of supratarsal triamcinolone for treatment of vernal keratoconjunctivitis in Ireland. Cornea, 2019, 38(8): 955-958.

1. Xiong XF, Xu L, Fan LL, et al. Long-term follow-up of self-expandable metallic stents in benign tracheobronchial stenosis: a retrospective study. BMC Pulm Med, 2019, 19(1): 33.
2. Fortin M, Lacasse Y, Elharrar X, et al. Safety and efficacy of a fully covered self-expandable metallic stent in benign airway stenosis. Respiration, 2017, 93(6): 430-435.
3. Kniese CM, Musani AI. Interventional pulmonology: a focused review for primary care physicians. Med Clin North Am, 2019, 103(3): 399-412.
4. Michaud G. Review of recent important papers in interventional pulmonology. Semin Thorac Cardiovasc Surg, 2018, 30(2): 212-214.
5. Mondoni M, Radovanovic D, Sotgiu G, et al. Interventional pulmonology techniques in elderly patients with comorbidities. Eur J Intern Med, 2019, 59: 14-20.
6. Khan HA, Sahibzada MN, Paracha MM. Comparison of the efficacy of intralesional bleomycin versus intralesional triamcinolone acetonide in the treatment of keloids. Dermatol Ther, 2019, 32(5): e13036.
7. 陳愉, 伍惠儀, 李時悅, 等. 局部注射曲安奈德結合常規介入方法治療難治性良性中央氣道狹窄療效及安全性的初步探討. 中華結核和呼吸雜志, 2012, 35(6): 415-418.
8. 李志東, 陳思宇, 肖誼, 等. 氣管鏡下介入高壓球囊擴張聯合局部注射激素治療氣道狹窄的臨床研究. 中國藥物經濟學, 2014, 9(S1): 404-405.
9. 胡鑫, 張會云, 邊南南, 等. 第二代ALK抑制劑治療ALK⁺非小細胞肺癌有效性單組率的Meta分析. 中國循證醫學雜志, 2018, 18(9): 918-923.
10. 周子青, 蘇柱泉, 唐純麗, 等. 局部噴灑曲安奈德聯合球囊擴張治療良性中央氣道狹窄療效研究. 新醫學, 2016, 47(11): 742-746.
11. 肖陽寶, 羅莉, 羅林紫, 等. 局部注射曲安奈德聯合常規介入方法治療結核性支氣管瘢痕狹窄. 當代醫學, 2018, 24(22): 35-37.
12. 蔡向敬, 侯玉蓮, 段月庭, 等. 支氣管鏡下球囊高壓擴張聯合曲安奈德局部注射治療結核性支氣管狹窄的效果觀察. 河北醫學, 2017, 23(12): 1956-1958.
13. 雷小婷, 孟泳, 包愛華, 等. 氣管鏡下球囊擴張聯合曲安奈德局部注射治療氣道狹窄的遠期療效. 中國實用醫刊, 2019, 46(4): 11-14.
14. 馬建永, 李春. 曲安奈德結合常規介入治療難治性良性中央氣道狹窄療效及安全性評價. 中國初級衛生保健, 2013, 27(4): 118-119.
15. 齊亞麗, 顧玉海, 李龍昱, 等. 局部注射曲安奈德結合常規介入方法治療難治生良性中央氣道狹窄療效及安全性的初步探討. 黑龍江醫藥, 2016, 29(4): 699-700.
16. 龍發, 周愛蓮, 李俊華, 等. 電子支氣管鏡下球囊高壓擴張加曲安奈德注射治療結核性支氣管狹窄的臨床研究. 臨床內科雜志, 2015, 32(11): 782-783.
17. Guibert N, Didier A, Moreno B, et al. Treatment of complex airway stenoses using patient-specific 3 D-engineered stents: a proof-of-concept study. Thorax, 2019, 74(8): 810-813.
18. Fiorelli A, Poggi C, Ardo NP, et al. Flow-volume curve analysis for predicting recurrence after endoscopic dilation of airway stenosis. Ann Thorac Surg, 2019, 108(1): 203-210.
19. Rezende MU, Andrusaitis FR, Silva RT, et al. Joint lavage followed by viscosupplementation and triamcinolone in patients with severe haemophilic arthropathy: objective functional results. Haemophilia, 2017, 23(2): e105-e115.
20. Elavarasi A, Goyal V, Singh MB, et al. Is triamcinolone an easy and efficient way to treat meralgia paresthetica? A Cohort Study. Ann Indian Acad Neurol, 2019, 22(3): 308-310.
21. McSwiney TJ, Power B, Murphy CC, et al. Safety and efficacy of supratarsal triamcinolone for treatment of vernal keratoconjunctivitis in Ireland. Cornea, 2019, 38(8): 955-958.

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Efficacy and safety of local triamcinolone combined with conventional interventional therapy in treatment of benign airway stenosis: a meta-analysis

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