高原性肺动脉高压药物预防的系统评价

Drugs for High Altitude Pulmonary Hypertension: A Systematic Review

目的系统评价高原性肺动脉高压的药物预防作用。方法电子检索Cochrane图书馆、PubMed、Elsevise、中国知网、万方数据库、维普数据库,检索时间2004年11月—2013年11月;检索语种:中文和英文。采用RevMan 5.0软件对符合纳入标准的文献采用固定效应模型或随机效应模型进行Meta分析。结果共纳入文献14篇,其中有关磷酸二酯酶抑制剂预防高原性肺动脉高压的文献9篇,有关波生坦的文献4篇,有关地塞米松的文献2篇,有关乙酰唑胺和银杏叶提取物的文献1篇。试验组共包括185例研究对象,安慰剂组共包括168例研究对象。14篇文献报道了药物对肺动脉压的影响,合并效应量MD=-6.22,95%CI(-8.24,-4.20),亚组分析显示磷酸二酯酶抑制剂、地塞米松与安慰剂间差异有统计学意义〔MD=-6.55,95%CI(-8.72,-4.37),P<0.00001;MD=-17.37,95%CI(-24.61,-10.13),P<0.00001〕,波生坦与安慰剂比较,差异无统计学意义〔MD=-2.39,95%CI(-7.20,2.42),P=0.33〕。共5篇文献报道了对心输出量的影响,试验组和安慰剂组间差异无统计学意义〔MD=0.55,95%CI(0.10,1.01),P=0.67〕,对其进行亚组分析,磷酸二酯酶抑制剂可增加心输出量,组间差异有统计学意义〔MD=0.65,95%CI(0.14,1.16),P=0.01〕。共8篇文献报道了对血压的影响,试验组和安慰剂组间差异无统计学意义〔MD=-2.68,95%CI(-6.28,0.92),P=0.57〕。共11篇文献报道了对心率的影响,试验组和安慰剂组间差异无统计学意义〔MD=-0.67,95%CI(-6.20,4.86),P=0.81〕,进一步行亚组分析,地塞米松可增加心输出量,组间差异有统计学意义〔MD=-16.60,95%CI(-29.22,-3.99),P=0.01)〕。共10篇文献报道了对血氧饱和度的影响,试验组和安慰剂组间差异无统计学意义〔MD=0.83,95%CI(-0.78,2.44),P=0.31〕。结论磷酸二酯酶抑制剂、地塞米松可有效预防低海拔人群暴露高原环境下肺动脉压的升高,而波生坦无效。

Objective This study performed a system evaluation to explore the prevention of drugs for high altitude pulmonary hypertension. Methods Cochrane library,PubMed,Elsevise,CNKI,Wanfang and Vip databases were searched for some relevant articles between November 2004 and 2013 which were published in Chinese and English. RevMan 5. 0 software was used for fixed or random effects model Meta - analysis of articles meeting the inclusion criteria. Results Finally,this study included 14 articles（9 articles about phosphodiesterase inhibitor,4 articles about bosentan,2 articles about dexamethasone and 1 article about acetazolamide with ginkgo biloba extract）. Subjects in all were involved including 185 in experimental group and 168 in placebo group. 14 articles reported the effectiveness of drugs on pulmonary artery pressure〔 MD = - 6. 22,95% CI （ - 8. 24, - 4. 20）〕. The subgroup analysis showed that placebo had significant difference with both phosphodiesterase inhibitor and dexamethasone〔MD = - 6. 55,95% CI（ - 8. 72, - 4. 37）,P 〈 0. 000 01;MD = - 17. 37,95% CI（ - 24. 61,- 10. 13）,P 〈 0. 000 01〕but no difference with the drug of bosentan〔MD = - 2. 39,95% CI（ - 7. 20,2. 42）,P = 0. 33〕. 5 articles reported the effectiveness of drugs on cardiac output. There was no significant difference between experimental group and placebo group〔MD = 0. 55,95% CI（0. 10,1. 01）,P = 0. 67〕. The subgroup analysis showed that phosphodiesterase in-hibitors could increase cardiac output,each subgroup had significant difference with each other〔MD = 0. 65,95% CI（0. 14, 1. 16）,P = 0. 01〕. 8 articles reported the effectiveness of drugs on blood pressure. There was no significant difference between experimental group and placebo group〔MD = - 2. 68,95% CI（ - 6. 28,0. 92）,P = 0. 57〕. 11 articles reported the effec-tiveness of drugs on heart rate. Two groups had no significant difference〔 MD = - 0. 67,95% CI（ - 6. 20,4. 86）,P =0. 81〕. The subgroup analysis showed that dexamethasone could increase cardiac output and each subgroup had significant differ-ence with each other〔MD = - 16. 60,95% CI（ - 29. 22, - 3. 99）,P = 0. 01〕. 10 articles reported the effectiveness of drugs on oxygen saturation. Two groups had no significant difference〔MD = 0. 83,95% CI（ - 0. 78,2. 44）,P = 0. 31〕. Conclusion Phosphodiesterase inhibitors and dexamethasone can effectively prevent pulmonary artery pressure to rise who came from lower altitude and exposed in plateau in a short time. However,bosentan was ineffective.