靶向药物联合治疗肺动脉高压的荟萃分析

发布时间：2018-05-25 11:06

  本文选题：肺动脉高压 + 联合治疗　； 参考：《广西医科大学》2017年硕士论文

【摘要】：目的:评价靶向药物联合治疗肺动脉高压的有效性及安全性。方法:计算机检索PubMed、Cochrane数据库、中国生物医学文献数据库(CBM)、中国知识资源总库(CNKI)、万方等数据库,检索时间为数据库建立至2017年4月。纳入关于靶向药物联合治疗肺动脉高压的临床随机对照试验,并以死亡率、临床恶化率、WHO功能分级、6分钟步行试验(6MWD)、血流动力学指标(平均肺动脉压力、肺循环阻力)等作为评价指标。对检索所得文献进行筛检,提取相关数据,计数资料以相对风险比(relative ratio,RR)及其95%可信区间(confidence interval,CI)表示,计量资料则以均数差(mean difference,MD)及其95%CI表示,用RevMan5.3软件进行统计分析并得出相关结果,再对结果进行评价讨论。当异质性较小时采用固定效应模型,否则采用随机效应模型。结果:共纳入随机对照研究19个,总样本量4202名患者。META结果显示:与单药治疗组相比,联合治疗组可显著降低临床恶化率[RR=0.62,95%CI(0.54,0.70),P0.00001]、提高患者6分钟步行距离[MD=26.81m,95%CI(14.68,38.95),P0.0001]、提高患者WHO功能分级[RR=1.19,95%CI(1.01,1.40),P0.04]、降低患者平均肺动脉压力[MD=-5.9mmHg,95%CI(-8.48,-3.32),P0.00001],以及肺循环阻力[MD=-214.74dyn.s-1.cm-5,95%CI(-269.50,-159.97),P0.00001],对于病死率,两组差异无统计学意义(P=0.1)。两组因各种原因中途退出试验的人数比例差异有统计学意义(P=0.0009),联合治疗组较单药治疗组高。结论:根据本研究,可认为靶向药物联合治疗较单药治疗后可改善患者的运动耐量、肺血流动力学指标,降低临床恶化的风险。然而,联合治疗较单药治疗不能降低患者的病死率,并且耐受性欠佳。
[Abstract]:Objective: to evaluate the efficacy and safety of targeted drugs in the treatment of pulmonary hypertension. Methods: the databases of PubMedus Cochrane, Chinese biomedical literature, CNKI and Wanfang were searched by computer. The retrieval time was established until April 2017. A randomized controlled trial was conducted on the combination of targeted drugs in the treatment of pulmonary hypertension. The mortality, the clinical deterioration rate and the WHO functional grading were measured in a 6-minute walking test with a hemodynamic index (mean pulmonary artery pressure, mean pulmonary artery pressure). Pulmonary vascular resistance) was used as evaluation index. The retrieved literature was screened, the relevant data were extracted, the counting data were expressed as relative risk ratio (RR) and its 95% confidence intervalCI, and the measured data were expressed in the mean difference (mean difference) and its 95%CI. RevMan5.3 software is used for statistical analysis and relevant results are obtained, and then the results are evaluated and discussed. When the heterogeneity is small, the fixed effect model is adopted, otherwise the random effect model is adopted. Results: a total of 19 randomized controlled trials were conducted. The total sample size of 4202 patients. Meta results showed that: compared with the single drug treatment group, 鑱斿悎娌荤枟缁勫彲鏄捐憲闄嶄綆涓村簥鎭跺寲鐜嘯RR=0.62,95%CI(0.54,0.70),P0.00001],鎻愰珮鎮ｈ，

本文编号：1933212