磷酸二酯酶-5抑制剂治疗慢性肺部疾病相关PH的系统评价  

Systematic evaluation of phosphodiesterase-5 inhibitors in the treatment of pulmonary hypertension associated with chronic lung diseases

作　　者：文建全 刘笑言 张春容[3] WEN Jianquan;LIU Xiaoyan;ZHANG Chunrong(Department of General Medicine,Yongchuan Hospital Affiliated to Chongqing Medical University,Chongqing 402160,China;Department of Neurosurgery,Yongchuan Hospital Affiliated to Chongqing Medical University,Chongqing 402160,China;Department of Emergency Medicine,Yongchuan Hospital Affiliated to Chongqing Medical University,Chongqing 402160,China)

机构地区：[1]重庆医科大学附属永川医院全科医学,重庆402160 [2]重庆医科大学附属永川医院神经外科,重庆402160 [3]重庆医科大学附属永川医院急诊科,重庆402160

出　　处：《中国医药科学》2021年第21期229-233,共5页China Medicine And Pharmacy

摘　　要：目的系统评价磷酸二酯酶-5抑制剂(PDE5i)治疗慢性肺部疾病相关PH的有效性及安全性。方法系统检索PubMed、EMBASE、Cochrane图书馆、中国知网、万方及维普数据库,检索时间为从建库至2020年7月,纳入关于PDE5i治疗慢性肺部疾病相关PH的随机对照试验(RCT),运用Stata 13.1软件对效应值进行meta分析。结果本文共纳入7项RCTs,包含553例患者。研究结果显示:PDE5i可改善慢性肺部疾病相关PH患者的6 MWD[MD=24.32,95%CI(7.52,41.12),P=0.005]、mPAP[MD=-2.74,95%CI(-4.32,-1.25),P<0.001]及PASP[MD=-5.63,95%CI(-9.18,-2.07),P=0.002],不能改善Borg呼吸困难指数[MD=-0.11,95%CI(-1.15,0.93),P=0.836]、SGRQ评分[MD=-7.14,95%CI(-17.55,3.26),P=0.178]及SF-36评分[MD=2.59,95%CI(-1.65,6.83),P=0.232],同时增加了胃肠道不良反应的发生风险[RR=2.28,95%CI(1.29,4.02),P=0.005]。结论现有证据表明PDE5i可有效治疗慢性肺部疾病相关PH,且无严重药物不良反应。以上发现可能需要更多相关临床研究进行验证。Objective To systematically evaluate the effectiveness and safety of phosphodiesterase-5 inhibitors(PDE5i)in the treatment of pulmonary hypertension(PH)associated with chronic lung diseases.Methods PubMed,Excerpta Medica Database(EMBASE),Cochrane Library,China National Knowledge Internet,Wanfang and VIP databases were systematically searched(from the establishment of databases to July 2020).The randomized controlled trials(RCT)on PDE5i in the treatment of PH associated with chronic lung diseases were included in this study,and Stata 13.1 software was adopted to perform meta-analysis of effect size.Results A total of 7 RCTs containing 553 patients were included in this study.The results showed that PDE5i improved 6-minute walking distance(6 MWD)(MD=24.32,95%CI[7.52,41.12],P=0.005),mean pulmonary arterial pressure(mPAP)(MD=-2.74,95%CI[-4.32,-1.25],P<0.001)and pulmonary artery systolic pressure(PASP)(MD=-5.63,95%CI[-9.18,-2.07],P=0.002),but did not improve the Borg dyspnea index(MD=-0.11,95%CI[-1.15,0.93],P=0.836),score of St George's respiratory questionnaire(SGRQ)(MD=-7.14,95%CI[-17.55,3.26],P=0.178)and Short Form 36-item(SF-36)score(MD=2.59,95%CI[-1.65,6.83],P=0.232).In addition,the results showed that PDE5i increased the risk of adverse gastrointestinal reactions(RR=2.28,95%CI[1.29,4.02],P=0.005).Conclusion The existing evidence suggests that PDE5i can effectively treat PH associated with chronic lung diseases without serious adverse drug reactions.The above findings need to be validated by more relevant clinical s tudies.

关 键 词：肺动脉高压 慢性阻塞性肺疾病 磷酸二酯酶-5抑制剂 缺氧 

分 类 号：R563[医药卫生—呼吸系统]