噻托溴铵吸入剂联合N-乙酰半胱氨酸泡腾片治疗慢性阻塞性肺疾病疗效的Meta分析  

A meta-analysis of the efficacy of tiotropium bromide inhalation combined with N-acetylcys⁃teine effervescent tablets in the treatment of chronic obstructive pulmonary disease

作　　者：赵瑞婧 王丽娜 李娜苗 高颖 刘美芳 张莹莹 范亚莉 鱼军[2] 李建英[1] ZHAORuijing;WANGLina;LINamiao;GAOYing;LIUMeifang;ZHANGYingying;FANYali;YU Jun;LI Jianying(Department of Respiratory and Critical Care Medicine,Xi'an Central Hospital,Xi'an,Shaanxi 710003,China;Department of Emergency,Xi'an Central Hospital,Xi'an,Shaanxi 710003,China;Medical College of Yan'an University,Yan'an,Shaanxi 716000,China)

机构地区：[1]西安市中心医院呼吸与危重症医学科,陕西西安710003 [2]西安市中心医院急诊科,陕西西安710003 [3]延安大学医学院,陕西延安716000

出　　处：《安徽医药》2021年第3期425-430,共6页Anhui Medical and Pharmaceutical Journal

基　　金：陕西省重点研发计划项目(2019SF-020)。

摘　　要：目的Meta分析法评价噻托溴铵联合N-乙酰半胱氨酸泡腾片较单用噻托溴铵治疗慢性阻塞性肺疾病的效果。方法系统检索PubMed、Medline、VIP等外文数据库及万方医学网、万方数据知识服务平台和中国知网(CNKI)等中文数据库建库至2019年11月,联合使用噻托溴铵、N-乙酰半胱氨酸泡腾片较单用噻托溴铵治疗慢性阻塞性肺疾病随机对照试验(RCT),用RevMan 5.3软件进行统计分析。结果共纳入8篇RCT,总计704例病人,观察组与对照组各352例。Meta分析结果:较单用噻托溴铵吸入相比,联合用药的结局指标除外第1秒用力呼气容积占预计值百分比(WMD=2.37,95%CI:−6.75~11.48,P=0.61)、改良英国呼吸困难MRC指数(WMD=−0.24,95%CI:−0.60~0.11,P=0.17),其临床有效率(RR=1.21,95%CI=1.12~1.31,P<0.00001)、第1秒用力呼气容积(WMD=0.26,95%CI:0.09~0.44,P=0.003)、用力肺活量(WMD=0.32,95%CI:0.27~0.38,P<0.00001)、第1秒用力呼气容积占用力肺活量比(WMD=7.74,95%CI:5.28~10.20,P<0.00001)、氧分压(WMD=10.70,95%CI:5.58~15.81,P<0.0001)、二氧化碳分压(WMD=−7.81,95%CI:−14.70~−0.91,P=0.03)。结论与单药相比,噻托溴铵联合N-乙酰半胱氨酸泡腾片治疗慢性阻塞性肺疾病的临床疗效更好,其血气分析、肺功能均有更显著地改善。Objective To evaluate the effect of tiotropium bromider powders combined with N-acetylcysteine effervescent tablets on the treatment of chronic obstructive pulmonary disease.Methods The PubMed、Medline、VIP、CNKI、Wanfang Medical Network and Wanfang Data were searched in English and Chinese from the date of establishment of databases to November 2019.Randomized controlled trials(RCTs)were chosen in which tiotropium bromider powders combined with N-acetylcysteine effervescent tablets was tak⁃en as observation group,while tiotropium bromider powders alone was taken as control group.statistical analysis using RevMan5.3 soft⁃ware.Results A total of 8 RCTswere included,with a total of 704 patients,Both the number of the observation group and the control group are 352 patients.Meta analysis results show that compared with the inhalation of tiotropium alone,the outcome indicators of the combined medication except the FEV1%pred(WMD=2.37,95%CI:−6.75-11.48,P=0.61)and MMRC(WMD=−0.24,95%CI:−0.60-0.11,P=0.17),its clinical effective rate(RR=1.21,95%CI=1.12-1.31,P<0.00001),FEV1(WMD=0.26,95%CI:0.09-0.44,P=0.003),FVC(WMD=0.32,95%CI:0.27-0.38,P<0.00001),FEV1/FVC(WMD=7.74,95%CI:5.28-10.20,P<0.00001),PaO2(WMD=10.70,95%CI:5.58-15.81,P<0.0001),PaCO2(WMD=−7.81,95%CI:−14.70-−0.91,P=0.03).Conclusion Compared with monotherapy,tiotropium bromide com⁃bined with N-acetylcysteine effervescent tablets has better clinical efficacy in the treatment of chronic obstructive pulmonary disease,and its blood gas analysis and lung function are improved more significantly.

关 键 词：肺疾病 慢性阻塞性 噻托溴铵 N-乙酰半胱氨酸 用力呼气量 最大呼气流量-容积曲线 META分析 

分 类 号：R563.9[医药卫生—呼吸系统]