硫酸镁治疗慢性阻塞性肺疾病的Meta分析

Magnesium sulfate for chronic obstructive pulmonary disease:a meta-analysis

目的系统评价硫酸镁治疗慢性阻塞性肺疾病的有效性与安全性。方法计算机检索Pubmed、Cochrane Library、Embase、CBM、CNKI、VIP、中华医学会数字化期刊、ISI Web of Knowledge等数据库。纳入硫酸镁静脉给药治疗慢性阻塞性肺疾病的随机对照试验（RCT）,检索时限均为建库至2015年2月。由2位研究者按照纳入与排除标准选择文献并进行质量评价,再采用RevMan 5.0软件进行Meta分析。结果共计15个RCT,955例患者。与对照组相比,硫酸镁有较高的临床体征改善率（OR=3.22,95%CI=1.87~5.55,P〈0.01）,能够改善患者第一秒用力呼气容积占预计值百分比（the first second forced expiratory volume percentage of expected value,FEV1%）（MD=10.17,95%CI=9.07~11.18,P〈0.01）。但是同对照组相比,硫酸镁对患者第一秒呼气量（forced expiratory volume in one second,FEV1）（MD=0.05,95%CI=0.00~0.10,P=0.03）、第一秒呼吸容积占用力肺活量百分比（the first seconds breathing volume percentage of forced vital capacity,FEV1/FVC）（MD=1.43,95%CI=0.00~2.85,P=0.05）、动脉血气pH（MD=-0.01,95%CI=-0.03~0.01,P=0.43）、动脉血气PO2（MD=-3.97,95%CI=-7.41~15.35,P=0.49）、动脉血气PCO2（MD=0.94,95%CI=-2.69~4.57,P=0.61）的改善均无显著影响,其不良反应发生率与对照组相似（MD=-0.94,95%CI=-0.23~0.04,P=0.19）。临床体征缓解率、不良反应发生率的漏斗图两侧显示不对称,提示纳入评价的文献存在发表性偏倚。结论静脉滴注硫酸镁可以显著改善患者肺功能的FEV1%,明显改善临床体征,且不良反应发生率较低,但对其他试验指标改善不明显。受纳入研究数量及质量限制,上述结论尚需要更多高质量、大样本、多中心的RCT加以验证。

Objective To systemically review the efficacy and safety of magnesium sulfate for chronic obstructive pulmonary disease（CODP）.Methods The randomized controlled trials（RCT）concerning magnesium sulfate for CODP from databases as Pubmed,Cochrane Library,Embase,CBM,CNKI,VIP,Chinese Medical Journal Digital and ISI Web of Knowledge published between inception to February 2015 were retrieved.Meta analysis on the selected literature was conducted by means of RevMan 5.0software.Two reviewers screened literature according to the inclusion and exclusion criteria,extract data and assessed methodological quality of included studies.Results A total of 14 RCTs involving 955 patients were included.Compared with control group,Magnesium sulfate had higher remission rate of clinical signs（OR =3.22,95%CI =1.87 to 5.55,P 0.01）,higher FEV1%（MD=10.17,95%CI=9.07 to 11.18,P 0.01）.However,compared with control group,magnesium sulfate had no significant differences in FEV1（MD=0.05,95%CI =0.00 to 0.10,P =0.03）,FEV1/FVC（MD=1.43,95%CI =0.00 to 2.85,P =0.05）,pH of arterial blood gas（MD=-0.01,95%CI =-0.03 to 0.01,P =0.43）,PO2 of arterial blood gas（MD=-3.97,95%CI =-7.41 to 15.35,P =0.49）,PCO2 of arterial blood gas（MD=0.94,95%CI =-2.69,4.57,P =0.61）,（MD=-0.94,95%CI =-0.23 to 0.04,P =0.19）.Funnel plot of the remission rate of clinical signs and incidence of adverse reactions were asymmetric,which indicated publication bias.Conclusion Magnesium sulfate of intravenous infusion could significantly improve the FEV1% of lung function of COPD patients.Furthermore,it could improve the remission rate of clinical signs and have a lower incidence of adverse reaction.But there is no significant difference with other indicators.Due to limited quantity and quality of the included studies,the conclusion above should be further verified by conducting more high quality,large scale,multicentre RCTs.