他汀类药物联合西地那非治疗肺动脉高压的Meta分析Meta-Analysis of Statins Combined with Sildenafil in the Treatment of Pulmonary Hypertension
陈聪,陈裕臻,李桃
CHEN Cong,CHEN Yuzhen,LI Tao
摘要(Abstract)：
目的系统评价他汀类药物联合西地那非治疗肺动脉高压(PAH)的疗效,为临床用药提供循证医学证据。方法使用计算机检索的方法,在中国知网数据库(CNKI)、万方数据库、维普中文生物医学期刊数据库、Pubmed数据库、Cochrance library以及康健外文医学期刊文献数据库检索有关他汀类药物联合西地那非治疗PAH的临床随机对照实验(RCT)的文献,用jadad量表对符合纳入标准的文献进行质量评价,并采用Cochrance协作网的Rev Man5.3软件进行Meta分析。结果共纳入10个RCT,593例PAH患者符合纳入标准。Meta分析结果显示:西地那非联合他汀类药物治疗PAH的平均肺动脉压(mPAP)[MD=-1.49,95%CI(-2.98,0.00),P=0.05],6 min步行距离(MWD)[MD=32.66,95%CI(18.34,46.98),P<0.000 01],心脏指数(CI)[MD=0.27,95%CI(0.07,0.46),P=0.008],C-反应蛋白(CRP)[MD=-5.37,95%CI(-8.78,-1.96),P=0.002]和N末端B型利钠肽原(NT-pro BNP)[MD=-37.29,95%CI(-53.77,20.81),P<0.000 01]与对照组相比差异有统计学意义。而动脉血氧分压(PaO_2)[MD=1.88,95%CI(-0.16,3.93),P=0.07],肺动脉收缩压(sPAP)[MD=-3.77,95%CI(-8.57,1.03),P=0.12],右心室收缩末期内径(RVSD)[MD=-0.60,95%CI(-3.51,2.30),P=0.68]与对照组相比,差异无统计学意义。结论在使用西地那非治疗PAH的基础上加用他汀类药物,疗效更为显著。
OBJECTIVE To systematically evaluate curative effect of statins combine with sildenafil on pulmonary arterial hypertension( PAH),and provide evidence for clinical medication. METHODS The literature on randomized controlled trial(RCT)about statins combine with sildenafil on PAH was searched among China National Knowledge Infrastructure( CNKI),Wanfang Data,VIP Chinese Medical Journal Database,Pubmed,Cochrane Library and Foreign Medical Journal Service( FMJS). The quality of literature that in accordance with the inclusive criteria with jaded scale was evaluated and Cochrane Collaboration's software Rev Man 5.3 was used for Meta-analysis. RESULTS 593 cases patients with PAH in 10 RCT were involved. Meta-analysis showed that therapeutic effect of statins combine with sildenafil on PAH had statistical significance on mean pulmonary artery pressure(mPAP) [MD=-1.49,95%CI(-2.98,0.00),P = 0.05],6-minute walking distance( MWD) [MD = 32.66,95% CI( 18.34,46.98),P < 0.000 01],cardiac index(CI) [MD = 0.27,95%CI( 0.07,0.46),P = 0.008],C-reactive protein( CRP) [MD =-5.37,95%CI(-8.78,-1.96),P =0.002],N-terminal pro-B natriuretic peptide( NT-pro BNP) [MD =-37.29,95%CI(-53.77,20.81),P<0.000 01]. However,there's no statistical significance on arterial partial pressure of oxygen( PaO_2) [MD = 1. 88,95% CI(-0. 16,3. 93),P = 0. 07],systolic pulmonary artery pressure(sPAP) [MD =-3. 77,95% CI(-8. 57,1. 03),P = 0. 12],right ventricular end systolic diameter[MD =-0.60,95%CI(-3.51,2.30),P = 0.68]. CONCLUSION Compared with control group,it would be a greater therapeutic effect on the treatment if statins is added on the basis of sildenafil.
关键词(KeyWords)：
他汀类药物;西地那非;肺动脉高压;联合用药;Meta分析
statins;sildenafil;drug combination;pulmonary hypertension;Meta-analysis
基金项目(Foundation):
作者(Author):
陈聪,陈裕臻,李桃
CHEN Cong,CHEN Yuzhen,LI Tao
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