LABA／LAMA和LABA／ICS治疗COPD稳定期的安全性及有效性荟萃分析  

Efficacy and safety of LABA/LAMA versus LABA/ICS for treatment of instable chronic obstructive pulmonary disease： a meta-analysis

作　　者：梅静静[1] 王焕勤[1] 刘媛华[1] 张业鹏[1] 刘红[1] 王静[1] Mei Jingjing;Wang Huanqin;Liu Yuanhua;Zhang Yepeng;Liu Hong;Wang Jing(Department of Respiratory and Critical Care Medicine,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,Chin)

机构地区：[1]郑州大学第一附属医院呼吸与危重症医学科,450052

出　　处：《国际呼吸杂志》2018年第14期1041-1048,共8页International Journal of Respiration

摘　　要：目的评价长效8受体激动剂／长效毒蕈碱拮抗剂（LABA／LAMA）与长效p受体激动剂／吸入糖皮质激素（LABA／Ics）治疗慢性阻塞性肺疾病（COPD）稳定期的有效性及安全性。方法全面检索PubMed、Embase、Cochrane Library、Ovid Medline数据库、中国期刊全文数据库及万方数据库，获取研究周期〉4周、对比LABA／LAMA与LABA／ICS治疗的随机对照研究（RCT），由2名研究者依照系统评价和荟萃分析优先报告的条目（PRISMA）进行文献筛选、数据提取以及质量评价，采用Revman5．3软件进行荟萃分析，根据不同LABA／LAMA治疗方案分组，进行亚组分析。结果共有9篇文献（10项RCT）纳入研究。荟萃分析结果显示：与LABA／Ics相比，LABA／LAMA治疗使第1秒用力呼气容积（FEV。）显著改善（MD0．09L，95％CI：0．08～0．11，P〈0．00001），显著降低了急性加重风险（OR=0．78，95％CI：0．64～0．94，P=0．01），肺炎发病风险也显著降低（OR=0．59，95％CI：0．43～0．81，P=0．001）。LABA／LAMA和LABA／Ics两组的SGRQ评分无显著差异（MD=0．66，95％CI：=1．36～O．04，P=0．07），严重不良反应发生率差异无统计学意义（OR一0．89，95％CI：0．77～1．04，P一0．14）。结论LABA／LAMA比LABA／ICS治疗COPD稳定期在改善患者肺功能、降低急性加重风险及降低肺炎发病风险方面更具优势。Objective To compare the efficacy and safety of long-actingbeta-agonist/long-acting musearinie antagonist （LABA/LAMA） versus long-actingbeta-agonist/inhaled corticosteroid （LABA/ ICS） for treatment of stable chronic obstructive pulmonary disease （COPD）. Methods Comprehensive searches were performed of the PubMed, Embase, Cochrane Library, Ovid, Wanfang and Chinese journal full-text database to acquire RCTs comparing LABA/LAMA treatment with LABA/ICS and duration of study 〉4 weeks. Two authors independently extracted data and assessed the methodological quality of the included studys following the preferred reporting items for systematic reviews and recta-analyses guidelines. Statistical analysis on the data was performed by RevMan 5.3 software and a subgroup analysis wasperformed by different LABA/LAMA combinations. Results Totally nine studies （ten RCTs） were included in the meta-analysis. Pooled analysis showed that compared to the LABA/ICS combinations, LABA/LAMA combinations significantly improved forced expiratory volume in one second （FEV1）（MD 0.09L,95% CI ：0.08-0.11, P〈0.000 01）, reduced risk of exacerbation （OR =0.78,95% CI ：0.64- 0.94, P=0.01） and risk of pneumonia （ OR=0. 59,95% CI ： 0.43-0.81, P = 0.001） dramatically. The improvement of St George＇s Respiratory Questionnaire scores was not different for LABA/LAMA versus LABA/ICS treatment （MD-0.66, 95% CI： =1.36-0.04, P = 0.07）, and the severe adverse event incidence between LABA/LAMA and LABA/ICS was similar （ OR = 0.89,95% CI ： 0.77 1.04, P = 0.14）. Conclusions Compared to the LABA/ICS combinations, LABA/LAMA combinationshad an advantage in the treatment of stable COPD in improving lung function, reducing acute exacerbation risk and reducing the risk of pneumonia.

关 键 词：长效Β受体激动剂 长效毒蕈碱拮抗剂 吸入糖皮质激素 慢性阻塞性肺疾病 荟萃 

分 类 号：R563.9[医药卫生—呼吸系统]