多索茶碱联合噻托溴铵治疗慢性阻塞性肺疾病的疗效及安全性评价  

Efficacy and safety evaluation of doxophylline combined with tiotropium bromide in the treatment of chronic obstructive pulmonary disease

作　　者：孙冰清 赵洪文[1] Sun Bingqing;Zhao Hongwen(Department of Respiratory and Critical Care Medicine,the First Affiliated Hospital of China Medical University,Shenyang 110001,China)

机构地区：[1]中国医科大学附属一院呼吸与危重症医学科,沈阳110001

出　　处：《国际呼吸杂志》2020年第17期1287-1298,共12页International Journal of Respiration

基　　金：国家"十三五""重大慢性非传染性疾病防控研究"专项(2016YFC1304301)。

摘　　要：目的系统评价多索茶碱联合噻托溴铵治疗慢性阻塞性肺疾病(COPD)的临床效果及安全性。方法用计算机检索CNKI、PubMed、Cochrane Library、万方、维普、VIP、CBM数据库,检索年限为自建库以来至2019年2月,纳入符合条件的临床随机对照试验,并采用Review Manager 5.3进行分析。结果最终纳入28篇合格文献,包括2767例患者,分析结果显示,在常规治疗的基础上加用多索茶碱对COPD患者的肺功能第1秒用力呼气容积(FEV1)(P<0.00001,总体MD=0.23,95%CI:0.15~0.31)、用力肺活量(FVC)(P=0.0003,总体MD=0.15,95%CI:0.07~0.23)以及一秒率(FEV1/FVC)(P<0.0001,总体MD=3.91,95%CI:1.99~5.84)有改善作用,并且与单用多索茶碱相比,在使用多索茶碱的基础上联合噻托溴铵则进一步提高了临床总体有效率(P<0.00001,总体OR=5.73,95%CI:4.27~7.69),改善了肺功能FEV1(P<0.00001,总体MD=0.45,95%CI:0.39~0.51)、FVC(P<0.00001,总体MD=0.35,95%CI:0.27~0.44)以及FEV1/FVC(P<0.00001,总体MD=7.22,95%CI:6.73~7.71),并且降低了不良反应发生率(P<0.0001,总体OR=0.39,95%CI:0.26~0.61)。结论在常规治疗的基础上加用多索茶碱对COPD患者有积极的治疗意义,同时多索茶碱使用过程中配合噻托溴铵进行治疗COPD患者不但能进一步提高疗效,显著改善肺功能,而且具有安全性。Objective To systematically evaluate the clinical efficacy and safety of doxofylline combined with tiotropium bromide in the treatment of patients with chronic obstructive pulmonary disease (COPD).Methods The CNKI, PubMed, Cochrane Library, Wanfang, Weipu, VIP and CBM databases were searched by computer from the date of their establishment to February 2019.Eligible clinical randomized controlled trials were included, reviewed and analyzed by using Review Manager 5.3.Results A total of 28 eligible literatures which involved 2 767 patients were included.On the basis of the conventional therapy, the use of doxofylline on patients with COPD can improve forced expiratory volume in one second (FEV1)(P<0.000 01, overall MD=0.23, 95%CI: 0.15-0.31), forced vital capacity (FVC) (P=0.000 3, overall MD=0.15, 95%CI: 0.07-0.23) and FEV1/FVC (P<0.000 1, overall MD=3.91, 95%CI: 1.99-5.84). The analysis also demonstrated that compared with doxofylline alone, doxofylline combined with tiotropium bromide to treat COPD patients can increase the overall clinical effectiveness rate (P<0.000 01, overall OR=5.73, 95%CI: 4.27-7.69), improve lung function FEV1 (P<0.000 01, overall MD=0.45, 95%CI: 0.39-0.51), FVC (P<0.000 01, overall MD=0.35, 95%CI: 0.27-0.44) and FEV1/FVC (P<0.000 01, overall MD=7.22, 95%CI: 6.73-7.71), and reduce the incidence of adverse reactions (P<0.000 1, overall OR=0.39, 95%CI: 0.26-0.61).Conclusions On the basis of conventional therapy, the use of doxofylline has a positive effect on the patients with COPD.The treatment of COPD by combining doxofylline with tiotropium bromide can not only increase the efficacy and improve lung function even further, but also reduce the incidence of adverse reactions and guarantee the safety of drug use.

关 键 词：肺疾病 慢性阻塞性 疗效 多索茶碱 噻托溴铵 安全性 

分 类 号：R563.9[医药卫生—呼吸系统]