腹主动脉瘤的药物治疗进展:一项系统综述和网状荟萃分析

Pharmacological treatment of abdominal aortic aneurysm:a systematic review and network Meta-analysis

目的利用网状荟萃分析寻找可以预防腹主动脉瘤扩张和破裂的药物,并对最新的研究进展进行综述。方法检索PubMed、Embase、Web of Science和Cochrane数据库,纳入截至2023年6月30日的针对腹主动脉瘤患者的药物治疗的随机对照试验,主要结局为腹主动脉瘤相关事件,即动脉瘤扩张或破裂。使用累积排序(SUCRA)曲线下的面积对干预药物进行排序,网状荟萃分析(NMA)在贝叶斯框架下进行,旨在探索可用于预防腹主动脉瘤扩张和破裂的药物。结果共纳入了10项随机对照研究,包括2234例腹主动脉瘤患者。接受药物治疗的患者与接受安慰剂治疗的患者在腹主动脉瘤相关事件的发生率上无明显差异,汇总的相对危险度(RR)分别为:氨氯地平0.85(95%CI:0.28~2.58),阿奇霉素1.24(95%CI:0.51~3.07),多西环素0.98(95%CI:0.55~1.72),吡嘧司特2.39(95%CI:0.57~18.45),培哚普利1.21(95%CI:0.43~3.39),普萘洛尔1.22(95%CI:0.69~2.11),罗红霉素0.80(95%CI:0.22~2.66),替米沙坦1.32(95%CI:0.47~3.83)。其中5项研究(共包括1284例患者)报道了与药物治疗相关的不良事件,与安慰剂对比,多西环素、吡嘧司特和替米沙坦在不良事件的发生风险方面并无明显差异,汇总的RR值分别为1.06(95%CI:0.95~1.18)、1.01(95%CI:0.88~1.17)和1.07(95%CI:0.85~1.37)。结论网状荟萃分析结果表明,目前没有可有效治疗腹主动脉瘤的药物,仍需进一步的前瞻性随机对照试验研究。

Objective To identify potential therapeutic agents for abdominal aortic aneurysm(AAA)patients by conducting a network Meta-analysis(NMA)and systematic review.Methods A literature search was conducted in PubMed,Embase,Web of Science,and Cochrane to identify randomized controlled trials(RCTs)on patients with AAA for further analysis.The primary outcome was AAA events,which were defined as AAA dilation or rupture.The surface under the cumulative ranking curve(SUCRA)probability values were applied to rank the drugs.The Bayesian framework was used in an NMA to investigate drugs that could prevent dilatation and rupture of AAA.Results A total of 10 RCTs including 2234 patients with AAA were included.Patients under pharmacological therapies exhibited a comparable incidence of AAA events to those treated with placebo,with a pooled relative risk(RR)of 0.85(95%confidence interval[CI]:0.28-2.58),1.24(95%CI:0.51-3.07),0.98(95%CI:0.55-1.72),2.39(95%CI:0.57-18.45),1.21(95%CI:0.43-3.39),1.22(95%CI:0.69-2.11),0.80(95%CI:0.22-2.66),and 1.32(95%CI:0.47-3.83)for amlodipine,azithromycin,doxycycline,pemirolast,perindopril,propranolol,roxithromycin,and telmisartan,respectively.A total of 5 studies(1284 patients)reported adverse events associated with drug therapy.There was no significant difference in the risk of adverse events with doxycycline,pimirolast,and telmisartan compared with placebo,and the pooled RR values were 1.06(95%CI:0.95-1.18),1.01(95%CI:0.88-1.17),and 1.07(95%CI:0.85-1.37),respectively.Conclusion This NMA demonstrated that no drugs have a definitive therapeutic effect on AAA,and further prospective RCTs are still required.