血管紧张素抑制药联合糖皮质激素对特发性肺纤维化作用的系统评价

发布时间：2018-11-22 18:38

【摘要】：目的系统评价血管紧张素抑制剂(ARB)联合糖皮质激素治疗特发性肺纤维化(IPF)的临床疗效。方法计算机系统检索Pub Med、Em Base、Cochrane Library、相关期刊论文(CNKI)、中国生物医学文献数据库(CBM)、维普中文科技期刊数据库(VIP)、万方数字化期刊全文数据库(Wanfang Database),检索时限均从建库至2017年3月,同时补充互联网及手工检索到的文献,纳入有ARB联合糖皮质激素治疗特发性肺纤维化的随机对照试验(RCT)和半随机对照试验(quasi-RCT),并追溯纳入文献的参考文献。由2名研究者按入选与排除标准独立筛选文献、提取资料并按照Cochrane系统评价手册推荐的方法评价文献质量,用Rev Man5.3进行Meta分析,系统评价ARB联合糖皮质激素治疗特发性肺纤维化的疗效。结果共纳入14个RCT,包括1239例患者,试验组621例,对照组618例。Meta分析显示,与对照组比较,试验组对临床有效率(OR=2.78,95%CI:2.12~3.66,P0.001)、动脉血氧分压(PaO_2,MD=8.76,95%CI:7.26~10.26),P0.001)、动脉血二氧化碳分压(PaCO_2,MD=-14.04,95%CI:-15.03~-13.05,P0.001)、用力肺活量(FVC,MD=0.74,95%CI:0.55~0.94),P0.001)、1秒用力呼气容积(FEV1,MD=0.74,95%CI:0.63~0.86,P0.001)、一氧化碳弥散量(DLCO,MD=3.70,95%CI:1.88~5.51,P0.001)、肺活量(VC,MD=5.23,95%CI:3.38~7.08,P0.001)的改善作用更显著,差异均有统计学意义。结论 ARB联合糖皮质激素用于治疗特发性肺纤维化可改善患者的临床情况、提高血氧分压、降低二氧化碳分压、改善用力肺活量、1秒用力呼气容积、一氧化碳弥散量和肺活量。
[Abstract]:Objective to evaluate the clinical effect of angiotensin inhibitor (ARB) combined with glucocorticoid on idiopathic pulmonary fibrosis (IPF). Methods Pub Med,Em Base,Cochrane Library, full text database of Chinese periodicals (CNKI), Chinese biomedical literature database (CBM), Weipu Chinese science and technology journal database (VIP), The (Wanfang Database), retrieval time limit of the full text database of Wanfang Digital Journals is from the establishment of the database to March 2017, and it also supplements the literature retrieved by the Internet and by hand. A randomized controlled trial (RCT) and a semi-randomized controlled trial (quasi-RCT) with ARB combined with glucocorticoid for the treatment of idiopathic pulmonary fibrosis were included. According to the criteria of inclusion and exclusion, two researchers independently sifted the literature, extracted the data and evaluated the quality of the literature according to the method recommended by the Cochrane system evaluation manual, and analyzed the quality of the literature by Rev Man5.3. To evaluate the efficacy of ARB combined with glucocorticoid in the treatment of idiopathic pulmonary fibrosis. Results A total of 14 RCT, patients were included, including 1239 patients, 621 patients in the trial group and 618 patients in the control group. Meta analysis showed that compared with the control group, the clinical effective rate (OR=2.78,95%CI:2.12~3.66,P0.001) of the trial group was higher than that of the control group. Arterial partial pressure of oxygen (PaO_2,MD=8.76,95%CI:7.26~10.26), P0.001), partial pressure of arterial blood carbon dioxide (PaCO_2,MD=-14.04,95%CI:-15.03~-13.05,P0.001), forced vital capacity (FVC,) MD=0.74,95%CI:0.55~0.94, P0.001), 1 second forced expiratory volume (FEV1,MD=0.74,95%CI:0.63~0.86,P0.001), carbon monoxide diffusion volume (DLCO,MD=3.70,95%CI:1.88~5.51,P0.001), The improvement of vital capacity (VC,MD=5.23,95%CI:3.38~7.08,P0.001) was more significant, and the difference was statistically significant. Conclusion ARB combined with glucocorticoid in the treatment of idiopathic pulmonary fibrosis can improve the clinical condition, increase partial pressure of oxygen, decrease partial pressure of carbon dioxide, improve forced vital capacity, forced expiratory volume in 1 second, diffusion capacity of carbon monoxide and vital capacity.
【作者单位】：南京中医药大学附属医院江苏省中医院呼吸科;
【基金】：国家自然科学基金资助项目(81673936)
【分类号】：R563

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