垂体后叶素联合酚妥拉明治疗肺结核咯血的疗效及安全性的系统评价

Effectiveness and safety of pituitrin combined with phentolamine in the treatment of phthisic hemoptysis: A systematic review

目的:系统评价垂体后叶素联合酚妥拉明治疗肺结核咯血的疗效和安全性。方法:计算机检索Pub Med、EMbase、The Cochrane Library、CNKI、Wan Fang Data、CBM和VIP,检索时限截至2015年6月,纳入垂体后叶素联合酚妥拉明治疗肺结核咯血的相关随机对照试验(RCT)。由2位研究人员根据纳入与排除标准独立进行文献筛选、数据提取、质量评价并交叉核对结果。然后采用Rev Man 5.2.3软件进行Meta分析。结果:共纳入15个RCT。Meta分析结果显示:(1)垂体后叶素联合酚妥拉明组对比垂体后叶素组能提高显效率[RR=1.59,95%CI(1.36,1.86),P<0.000 01]和有效率[RR=1.31,95%CI(1.21,1.42),P<0.000 01],缩短其咯血停止或缓解的时间[MD=-1.89,95%CI(-3.03,-0.74),P=0.001]。(2)垂体后叶素联合酚妥拉明组对比垂体后叶素组能降低其腹痛[OR=0.08,95%CI(0.01,0.62),P=0.01]和血压升高[OR=0.06,95%CI(0.01,0.71),P=0.03]的发生率,头晕[OR=0.07,95%CI(0.00,1.21),P=0.07]发生率无统计学意义。(3)垂体后叶素联合酚妥拉明组对比酚妥拉明组能提高显效率[RR=1.50,95%CI(1.12,2.01),P=0.006]和有效率[RR=1.33,95%CI(1.15,1.54),P=0.000 2],缩短其咯血停止或缓解的时间[MD=-1.35,95%CI(-1.90,-0.80),P<0.000 01]。(4)垂体后叶素联合酚妥拉明组对比酚妥拉明组能降低其头晕[OR=0.07,95%CI(0.02,0.25),P<0.000 1]的发生率,腹痛[OR=0.21,95%CI(0.04,1.04),P=0.06]和血压升高[OR=1.22,95%CI(0.07,21.18),P=0.89]发生率无统计学意义。结论:垂体后叶素联合酚妥拉明组能提高垂体后叶素组的显效率和有效率、缩短咯血停止或缓解的时间,并减少腹痛、血压升高的发生率,其2组头晕发生率无统计学意义;垂体后叶素联合酚妥拉明组能提高酚妥拉明组的显效率和有效率、缩短咯血停止或缓解的时间,并减少头晕发生率,其2组腹痛和血压升高发生率无统计学意义。

OBJECTIVE To systematically assess effectiveness and safety of pituitrin combined with phentolamine in the treatment of phthisic hemoptysis. METHODS Databases including Pub Med,EMbase,Cochrane Library,CNKI,Wan Fang Data,CBM and VIP were electronically searched from inception to June,2015,for randomized controlled trials（ RCTs） on pituitrin combined with phentolamine in the treatment of phthisic hemoptysis. Two reviewers independently screened literatures,extracted data,and assessed methodological quality of included studies. Then meta-analysis was performed using Rev Man 5. 2. 3 software. RESULTS Fifteen RCTs were included. RESULTS Of meta-analysis indicated that pituitrin combined with phentolamine significantly increased significant efficiency [RR = 1. 59,95% CI（ 1. 36,1. 86）,P〈0. 000 01] and efficiency [RR = 1. 31,95% CI（ 1. 21,1. 42）,P〈0. 000 01],and shorten the stop or remission time of hemoptysis [MD =- 1. 89,95% CI（- 3. 03,- 0. 74）,P = 0. 001]compared with pituitrin alone. Pituitrin combined with phentolamine versus pituitrin alone could reduce incidences of abdominal pain [OR = 0. 08,95% CI（ 0. 01,0. 62）,P = 0. 01]and hypertension[OR = 0. 06,95% CI（ 0. 01,0. 71）,P = 0. 03]. No significant difference was observed in incidence of dizziness [OR = 0. 07,95% CI（ 0. 00,1. 21）,P = 0. 07] between two groups. Phentolamine combined with pituitrin versus phentolamine alone could increase incidences of significant efficiency [RR = 1. 50,95% CI（ 1. 12,2. 01）,P = 0. 006]and efficiency [RR = 1. 33,95% CI（ 1. 15,1. 54）,P = 0. 000 2],shorten the stop or remission time of hemoptysis [MD =- 1. 35,95%CI（- 1. 90,- 0. 80）,P〈0. 000 01]. Phentolamine combined with pituitrin versus phentolamine alone could reduce incidence of dizziness [OR = 0. 07,95% CI（ 0. 02,0. 25）,P〈0. 0001],but produce no impact on abdominal pain [OR = 0. 21,95% CI（ 0. 04,1. 04）,P = 0. 06]or hypertension [OR = 1. 22,95% CI（ 0. 07,21. 18）,P = 0. 89]. CONCLUSION Pituitrin combined with phentolamine can elevate significant efficiency and efficiency,shorten the stop or remission time of hemoptysis,reduce incidences of abdominal pain and hypertension,but has no significant effects on incidence of dizziness. Pituitrin combined with phentolamine can significant increase significant efficiency and efficiency,shorten the stop or remission time of hemoptysis,and reduce incidence of dizziness compared with pituitrin alone,but will not significantly affect incidence of abdominal pain or hypertension.