基于网状Meta分析比较不同剂量利伐沙班治疗肺栓塞患者的临床疗效  

Clinical Efficacy of Rivaroxaban at Different Doses in Patients with Pulmonary Embolism:A Network Meta-Analysis

作　　者：汪雁博[1] 刘畅畅 苏利芳 周庆 郝国贞[1] 谷新顺[1] WANG Yan-bo;LIU Chang-chang;SU Li-fang;ZHOU Qing;HAO Guo-zhen;GU Xin-shun(Department of Cardiology V,the Second Hospital of Hebei Medical University,Shijiazhuang 050000,China)

机构地区：[1]河北医科大学第二医院心血管内五科,石家庄050000

出　　处：《中国合理用药探索》2023年第11期85-98,共14页Chinese Journal of Rational Drug Use

摘　　要：目的:基于网状Meta分析方法比较不同剂量利伐沙班治疗我国肺栓塞(PE)患者的临床疗效。方法:检索中国知网、万方数据库、维普中文期刊服务平台和Pubmed等数据库自建库至2022年12月期间已经发表的关于利伐沙班治疗PE的期刊论文和学位论文,筛选与本研究相关的文献并获取全文,其中结局指标包括总有效率、D-二聚体水平、动脉血氧分压(PaO2)和不良反应发生率。采用Reviewmanager5.0和StataSE16软件对数据进行处理与统计,分析不同剂量利伐沙班治疗PE的有效性以及对D-二聚体、PaO2和不良反应发生率的影响。结果:最终入选37项符合条件的临床研究进行Meta分析,共涉及患者2481例,其中对照组使用华法林治疗(n=1250),试验组使用不同剂量利伐沙班治疗(n=1231),根据利伐沙班的用量进行分组,分别为利伐沙班10mg/d(利伐沙班1)、利伐沙班15mg/d序贯10mg/d(利伐沙班2)、利伐沙班15mg/d(利伐沙班3)、利伐沙班15mg/d序贯20mg/d(利伐沙班4)和利伐沙班20mg/d(利伐沙班5)。5种剂量利伐沙班治疗PE总有效率均优于华法林,其中利伐沙班5疗效最佳。不同剂量利伐沙班治疗对D-二聚体水平影响无明显差异。利伐沙班5和利伐沙班3治疗后PaO_(2)高于华法林,利伐沙班5治疗后PaO_(2)高于利伐沙班1、利伐沙班2和利伐沙班4,利伐沙班5疗效最佳。不同剂量利伐沙班治疗的不良反应均低于华法林,利伐沙班3不良反应最小。结论:与华法林相比,不同剂量利伐沙班治疗我国PE患者均安全有效,其中利伐沙班20mg/d的方法有效性最好,利伐沙班15mg/d的不良反应最小。Objective:To compare the clinical efficacy of rivaroxaban at different doses in the treatment of Chinese patients with pulmonary embolism(PE)using the network meta-analysis.Methods:We searched CNKI,Wanfang database,and VIP Chinese journal service platforms and the Pubmed database for journal articles and academic theses on rivaroxaban in the treatment of PE published from a defined date to December 2022.Then,articles related to the present study were screened and their full-text articles were downloaded.The outcome parameters included total response rate,D-dimer level,partial pressure of oxygen(PaO2)and incidence of adverse reactions.Relevant data were handled and statistically summarized using Review manager 5.0 and Stata SE 16 software to analyze the efficacy of rivaroxaban at different doses in the treatment of PE and its effects on the D-dimer and PaO_(2) values and the incidence of adverse reactions.Results:Finally 37 clinical studies meeting the selection criteria were selected for meta-analysis.A total of 2481 patients were included,including 1250 patients in the control group treated by warfarin and 1231 patients in the experimental groups treated with different doses of rivaroxaban and further divided into 5 groups:rivaroxaban 10mg/d(rivaroxaban 1),rivaroxaban 15mg/d sequential 10mg/d(rivaroxaban 2),rivaroxaban 15mg/d(rivaroxaban 3),rivaroxaban 15mg/d sequential 20mg/d(rivaroxaban 4)and rivaroxaban 20mg/d(rivaroxaban 5).The 5 doses rivaroxaban all demonstrated a better total response rate than warfarin,and rivaroxaban 5 showed the best efficacy.Different doses of rivaroxaban did not show a significant difference in effect on the D-dimer level.After treatment,rivaroxaban 5 and rivaroxaban 3 were observed with a higher PaO_(2) value than warfarin,and rivaroxaban 5 was associated with a higher PaO2 value than rivaroxaban 1,rivaroxaban 2 and rivaroxaban 4.Rivaroxaban 5 showed the best efficacy.Different doses of rivaroxaban were all associated with a lower incidence of adverse reactions than warfarin,and riv

关 键 词：肺栓塞 华法林 利伐沙班 有效性 安全性 

分 类 号：R563.5[医药卫生—呼吸系统]