四种药物对急性高山病的预防效果:贝叶斯网状Meta分析  

The preventive effect of four drugs on acute mountain sickness:a Bayesian network meta-analysis

作　　者：杨海龙 邓满军 张伟[3] 黄珊 Yang Hailong;Deng Manjun;Zhang Wei;Huang Shan(The Second People′s Hospital of Xining,Xining 810003,China;Affiliated Hospital of Qinghai University,Xining 810008,China;Research Center for High Altitude Medicine Medical College of Qinghai University,Xining 810008,China)

机构地区：[1]西宁市第二人民医院,810003 [2]青海大学附属医院,西宁810008 [3]青海大学医学院高原医学研究中心,西宁810008

出　　处：《中华结核和呼吸杂志》2021年第11期953-960,共8页Chinese Journal of Tuberculosis and Respiratory Diseases

基　　金：国家自然科学基金(81560301)。

摘　　要：目的对比和预测乙酰唑胺等药物对急性高山病(AMS)的预防效果。方法遵循系统评价、Meta分析的PRISMA声明的检索策略,检索PubMed、Embase、Cochrane Library、Web of Science、CNKI、万方等数据库1980年1月1日至2020年12月30日符合药物预防AMS的随机对照研究(RCT),分析研究资料。使用R等统计软件在贝叶斯框架下采用马尔科夫链-蒙特卡罗法进行网状Meta分析,另外使用节点分离法对闭环研究进行一致性检验。结果最终纳入23篇文献(25项研究)对比了4种药物对AMS的预防效果,按照药物分组进行贝叶斯网状Meta分析,乙酰唑胺组、地塞米松组、银杏叶提取物组和红景天组中AMS发生率均低于安慰剂组;在不同药物的相互比较中,乙酰唑胺组、地塞米松组和红景天组AMS发生率低于银杏叶提取物组;而乙酰唑胺组、地塞米松组、红景天组之间AMS发生率差异未见统计学意义(P>0.05)。其中8项研究报道了2种药物对进入目标海拔人群脉搏血氧饱和度(SpO_(2))的影响,贝叶斯网状Meta分析结果显示:在目标海拔,红景天组的SpO_(2)高于乙酰唑胺组和安慰剂组,乙酰唑胺组与安慰剂组的SpO_(2)的差异并无统计学意义。预防AMS效果概率排序显示:乙酰唑胺组、地塞米松组、银杏叶提取物组、红景天组和安慰剂组发生AMS排名第5的概率分别为45.72%、48.80%、0、5.48%和0。提高目标海拔人群SpO_(2)概率排序显示:乙酰唑胺组、红景天组和安慰剂组在目标海拔提高SpO_(2)效果排名第1的概率分别为2.27%、97.66%和0.07%;直接比较结果和贝叶斯预测模型间接比较结果一致性较好,差异无统计学意义(P>0.05)。结论乙酰唑胺和地塞米松可有效预防AMS发生,应作为今后相关补充研究的首选药物。红景天在提升进入高海拔人群的SpO_(2)同时也可降低AMS的发生率,也应受到足够的重视。银杏叶提取物预防AMS效果不如上述3种药物,临床中应视情�Objective To compare and predict the preventive effects of acetazolamide and other drugs on acute mountain sickness(AMS).Methods Following the retrieval strategy of PRISMA statement of systematic review and meta-analysis,we searched the databases of PubMed,Embase,Cochrane Library,Web of Science,CNKI,Wanfang,etc.from January 1,1980 to November 30,2020,and randomized controlled trials(RCT)consistent with drug prevention of AMS were conducted.Using R and other statistical software,Markov chain-Monte Carlo method was carried out for network meta-analysis under Bayesian framework,and node separation method was performed to check the consistency of closed-loop research.Results Twenty-three literatures(25 studies)were included to compare the preventive effects of 4 drugs on AMS.Bayesian network meta-analysis showed that the incidence of AMS in acetazolamide group(ACE),dexamethasone group(DEX),ginkgo biloba extract group(GBE)and rhodiola group(RHO)was lower than that in placebo group(PLA).In the comparison of drug groups,the incidence of AMS in ACE,DEX and RHO was lower than that in GBE.There was no statistically significant difference in the incidence of AMS among ACE,DEX and RHO groups.Eight of these studies reported the effects of two drugs on pulse oxygen saturation(SpO_(2))in people entering the target altitude.Bayesian network meta-analysis showed that SpO_(2)in RHO was higher than that in ACE and PLA,but there was no statistically significant difference in SpO_(2)between ACE and PLA.The probability ranking of prevention AMS effect grade showed that the rank 5th probability of AMS in ACE,DEX,GBE,RHO and PLA was 45.72%,48.80%,0,5.48%and 0,respectively.The probability ranking of improving the SpO_(2)level of the target altitude population showed that the probability of the ACE,RHO and PLA ranking 1st in improving the SpO_(2)effect at the target altitude was 2.27%,97.66%and 0.07%,respectively;the results of direct comparison were in good agreement with those of Bayesian prediction model indirectly,and there was no sta

关 键 词：急性高山病 网状Meta分析 乙酰唑胺 地塞米松 红景天 银杏叶提取物 

分 类 号：R594.3[医药卫生—内科学]