三联吸入型药物治疗稳定期慢性阻塞性肺疾病有效性和安全性的网状Meta分析  

Efficacy and Safety of Triple Inhalation Drugs in the Treatment of Stable Chronic Obstructive Pulmonary Disease:a Network Meta-analysis

作　　者：王声祥 代文娟 颜晶晶 卢丹丹 WANG Shengxiang;DAI Wenjuan;YAN Jingjing;LU Dandan(Department of Pharmacy,Hebei Petrochina Central Hospital,Langfang 065000,China;Department of Respiratory,Hebei Petrochina Central Hospital,Langfang 065000,China)

机构地区：[1]河北中石油中心医院药学部,河北省廊坊市065000 [2]河北中石油中心医院呼吸科,河北省廊坊市065000

出　　处：《实用心脑肺血管病杂志》2025年第5期7-15,共9页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

基　　金：2022年廊坊市科学技术研究与发展计划自筹经费项目(2022013122)。

摘　　要：目的通过网状Meta分析系统评价三联吸入型药物治疗稳定期慢性阻塞性肺疾病(COPD)的有效性和安全性。方法计算机检索万方数据知识服务平台、中国知网、维普网、PubMed、Embase、Cochrane Librany、Web of Science公开发表的三联制剂或二联制剂治疗稳定期COPD有效性和安全性的研究,检索时限自建库至2024年7月。由两名研究人员按照文献纳入与排除标准独立筛选文献、提取资料并进行文献偏倚风险评估。绘制累积排序概率图并计算累积排序概率图下面积(SUCRA),绘制漏斗图以判断纳入文献是否存在发表偏倚。结果最终纳入随机对照试验12篇,共包含25562例患者,其中试验组10378例、对照组15184例。贝叶斯网状Meta分析结果显示:接受布地奈德/格隆溴铵/福莫特罗(以下简称BGF)治疗者第1秒用力呼气容积(FEV1)相对基线变化值大于接受格隆溴铵/福莫特罗(以下简称GFF)、布地奈德/福莫特罗干粉吸入剂(以下简称BUD/FORM)、布地奈德/福莫特罗气雾剂(以下简称BFF)治疗者(P<0.05)。接受倍氯米松/福莫特罗/格隆溴铵(以下简称BDP/FF/G)治疗者中重度急性加重发生率低于接受BGF、氟替卡松/乌美溴铵/维兰特罗(以下简称FF/UMEC/VI)及二联制剂〔倍氯米松/福莫特罗(以下简称BDP/FF)除外〕治疗者(P<0.05);接受BGF治疗者中重度急性加重发生率低于接受BFF、GFF治疗者(P<0.05);接受FF/UMEC/VI治疗者中重度急性加重发生率低于接受氟替卡松/维兰特罗(以下简称FF/VI)、BUD/FORM、乌美溴铵/维兰特罗(以下简称UMEC/VI)治疗者(P<0.05)。接受BGF治疗者肺炎发生率高于接受GFF治疗者(P<0.05);接受FF/UMEC/VI治疗者肺炎发生率高于接受BUD/FORM、UMEC/VI治疗者(P<0.05)。累计排序概率图分析结果显示,接受三联制剂治疗者FEV1相对基线变化值的SUCRA最大为BGF(99.8%),中重度急性加重发生率的SUCRA最大为BDP/FF/G(98.8%),肺炎发生率的SUCRA最大为BDP/Objective To systematically evaluate the efficacy and safety of triple inhalation drugs in the treatment of stable chronic obstructive pulmonary disease(COPD)by network meta-analysis.Methods Articles about the efficacy and safety of triple or dual inhalation drugs in the treatment of stable COPD published on Wanfang Data,CNKI,VIP,PubMed,Embase,Cochrane Library,and Web of Science were searched,with the search spanning from the inception of each database to July 2024.Two researchers independently screened the articles according to the inclusion and exclusion criteria,extracted the information and evaluated the quality of the articles.The cumulative ranking probability graph was drawn and the surface under the cumulative ranking area(SUCRA)was calculated,the funnel graph was drawn to judge whether there was publication bias in the included literature.Results Finally,12 randomized controlled trials were included,involving a total of 25562 patients,with 10378 in the experimental group and 15184 in the control group.The Bayesian network meta-analysis results showed that,the variation value of forced expiratory volume in one second(FEV1)relative to baseline in patients treated with BGF was greater than that in patients treated with GFF,BUD/FORM,and BFF(P<0.05).The incidence of moderate to severe acute exacerbation in patients treated with BDP/FF/G was lower than that in patients treated with BGF,FF/UMEC/VI,and dual inhalation drugs(excluding BDP/FF)(P<0.05).The incidence of moderate to severe acute exacerbation in patients treated with BGF was lower than that in patients treated with BFF and GFF(P<0.05).Similarly,the incidence of moderate to severe acute exacerbation in patients treated with FF/UMEC/VI was lower than that in patients treated with FF/VI,BUD/FORM,and UMEC/VI(P<0.05).Furthermore,the incidence of pneumonia in patients treated with BGF was higher than that in patients treated with GFF(P<0.05).Similarly,the incidence of pneumonia in patients treated with FF/UMEC/VI was higher than that in patients treated wit

关 键 词：肺疾病 慢性阻塞性 吸入药物 网状Meta分析 

分 类 号：R563.9[医药卫生—呼吸系统]