联合吸入噻托溴铵和沙美特罗/氟替卡松对稳定期慢性阻塞性肺疾病患者疗效的Meta分析

Therapeutic effect of salmetrol/fluticasone combined with tiotropium therapy in patients with chronic obstructive pulmonary disease in stable stage：a Meta-analysis

目的 系统评价联合吸入噻托溴铵和沙美特罗/氟替卡松对慢性阻塞性肺病（COPD）稳定期患者治疗作用.方法 计算机检索Pubmed、维普（VIP）、万方数据库、中国知网和中国生物医学文献数据库（CBM）中关于联合吸入噻托溴铵和沙美特罗/氟替卡松治疗稳定期慢性阻塞性肺疾病的随机对照试验,检索时限为建库至2013年6月.由研究者根据GRADE系统推荐分级方法,对纳入文献进行严格质量评价,对符合质量标准的文献进行Meta分析.统计学分析采用Review Manager 5.1和GRADEprofiler 3.6软件.结果 共纳入15篇研究,Meta分析结果显示：联合吸入沙美特罗/氟替卡松和噻托溴铵对第1秒用力呼气容积（FEV1）、FEV1/FVC（用力肺活量）和FEV1％（第1秒用力呼气容积占预计值的百分比）的改善作用与单独吸入噻托溴铵比较,差异有统计学意义[加权均数差（95％ CI）分别为0.19（0.13,0.26）、5.21（3.08,7.33）、5.64（3.79,7.48）].联合吸入沙美特罗/氟替卡松和噻托溴铵对FEV1、FEV1/FVC及FEV1％预计值改善作用与单独吸入沙美特罗/氟替卡松相比较,差异有统计学意义[加权均数差（95％ CI）分别为0.18（0.13,0.22）、5.95（3.27,8.64）、7.26（4.56,9.96）].结论 现有研究显示联合吸入沙美特罗/氟替卡松和噻托溴铵对COPD稳定期患者治疗作用优于单独吸入沙美特罗氟替卡松或单独吸入噻托溴铵.

Objective To evaluate the effect of salmetrol/fluticasone combined with tiotropium in the treatment of patients with stable chronic obstructive pulmonary disease （COPD） systematically.Methods Pubmed,Wanfang Date,VIP Data,China national knowledge internet （http//www.cnki.net） and CBM were searched for the Randomized controlled trials （RCTs） on salmetrol/fluticasone combined with tiotropium in the treatment of patients with stable chronic obstructive pulmonary disease from the date of establishment of the databases to June 2013.The researchers evaluated the included studies using GRADE.The extracted data were analyzed by Review Manager 5.1 and GRADE profiler 3.6.Results A total of fifteen studies were included.Results showed that the FEV1,FEV1/FVC and FEV1 ％ predicted of patients who treated with salmetrol/fluticasone combined with tiotropium were significantly improved,compared with inhaled tiotropium alone（WMD =0.19,95％ CI 0.13 to 0.26;WMD =5.21,95％CI 3.08 to 7.33,WMD =5.64,95％ CI 3.79 to 7.48）.We also evaluated the effect of salmetrol/fluticasone combined with tiotropium compared with inhaled salmetrol/fluticasone alone,the result demomstrated that the combined therapy group improved the FEV1,FEV1/FVC,FEV1 ％ predicted significantly（WMD =0.18,95 ％ CI 0.13 to 0.22 ; WMD =5.95,95 ％ CI 3.27 to 8.64,WMD =7.26,95％ CI 4.56 to 9.96）.Conclusion The current evidence shows compared with inhaled salmetrol/fluticasone or tiotropium alone,the effiency of combined therapy strategy is better.