布洛芬对比对乙酰氨基酚在发热儿童急性发热管理中的疗效：随机对照试验的系统评价与Meta分析。
完整摘要 · 中文译文
背景：布洛芬和对乙酰氨基酚是儿科实践中最广泛使用的退热药物。尽管其使用普遍，但关于二者在发热儿童中相对疗效的比较证据仍存在异质性，且临床推荐意见在不同指南和国家间存在差异。 目的：我们旨在通过仅纳入随机对照试验的系统评价和荟萃分析，评估布洛芬与对乙酰氨基酚在发热儿童中的比较退热疗效。 方法：采用预先制定的检索策略，在Scopus、PubMed和Web of Science中进行系统检索，该策略结合了布洛芬、扑热息痛/对乙酰氨基酚、发热/发热的/发热症以及儿科人群相关术语。主要结局为4小时时无发热儿童的比例。连续型结局包括4小时时体温下降幅度、前4小时内无发热时间以及0-8小时时间段加权体温总结差异。研究方案已在PROSPERO注册（CRD420261353471）。 结果：共识别479条记录；去除重复并筛选后，7项研究纳入定量合成。对于4小时时无发热状态这一主要结局，合并风险比为1.26（95%置信区间[CI] 0.88-1.80；p = 0.106）。布洛芬组4小时时体温下降幅度显著更大（平均差0.31 °C，p = 0.024）。0-8小时时间段加权体温总结结局在数值上倾向于布洛芬，但未达到统计学显著性（平均差 - 3.52，95% CI - 21.24至14.21；p = 0.240；I2 = 57.6%）。一项跨异质性连续结局的探索性标准化均数差分析（七项比较）得出接近无效的合并效应（Hedges' g - 0.08，95% CI - 0.40至0.25；p = 0.645；I2 = 84.0%）。 结论：主要结局——4小时时达到无发热状态的儿童比例——在布洛芬与对乙酰氨基酚之间无显著差异（风险比 1.26，95% CI 0.88-1.80；p = 0.106）。与对乙酰氨基酚相比，布洛芬在4小时时体温下降具有统计学上更大的幅度（平均差 0.31 °C），尽管该差异不太可能具有临床意义。这些发现提示布洛芬在降低体温方面具有边际性的定量优势，但两种药物之间无临床显著差异。
完整摘要 · 英文原文
BACKGROUND: Ibuprofen and acetaminophen are the most widely used antipyretic agents in pediatric practice. Despite their common use, comparative evidence on their relative efficacy in febrile children remains heterogeneous, and clinical recommendations vary across guidelines and countries. OBJECTIVE: We aimed to evaluate the comparative antipyretic efficacy of ibuprofen versus acetaminophen in febrile children through a systematic review and meta-analysis restricted to randomized controlled trials. METHODS: A systematic search was conducted in Scopus, PubMed, and Web of Science using a predefined strategy combining terms for ibuprofen, paracetamol/acetaminophen, fever/febrile/pyrexia, and pediatric populations. The primary outcome was the proportion of children afebrile at 4 h. Continuous outcomes included temperature reduction at 4 h, time without fever during the first 4 h, and time-weighted summary temperature differences over 0-8 h. The study protocol was registered in PROSPERO (CRD420261353471). RESULTS: A total of 479 records were identified; after duplicate removal and screening, seven studies were included in the quantitative synthesis. For the primary outcome of afebrile status at 4 h, the pooled risk ratio was 1.26 (95% confidence interval [CI] 0.88-1.80; p = 0.106). Temperature reduction at 4 h was significantly greater with ibuprofen (mean difference 0.31 °C, p = 0.024). The time-weighted summary temperature outcome over 0-8 h numerically favored ibuprofen but did not reach statistical significance (mean difference - 3.52, 95% CI - 21.24 to 14.21; p = 0.240; I2 = 57.6%). An exploratory standardized mean difference analysis across heterogeneous continuous outcomes (seven comparisons) yielded a near-null pooled effect (Hedges' g - 0.08, 95% CI - 0.40 to 0.25; p = 0.645; I2 = 84.0%). CONCLUSIONS: The primary outcome-the proportion of children achieving afebrile status at 4 h-did not differ significantly between ibuprofen and acetaminophen (risk ratio 1.26, 95% CI 0.88-1.80; p = 0.106). Ibuprofen produced a statistically greater reduction in temperature at 4 h compared with acetaminophen (mean difference 0.31 °C), although this difference is unlikely to be clinically meaningful. These findings suggest a marginal quantitative advantage of ibuprofen to decrease body temperature, without a clinically significant difference between the two agents.