美特罗/替卡松联用噻托溴铵治疗中重度慢性阻塞性肺病的Meta分析

Meta Analysis of Salmeterol/Ticasone Combined with Tiotropium in Moderate to Severe Chronic Obstructive Pulmonary Diseases

目的系统评价沙美特罗/替卡松联用噻托溴铵治疗中、重度慢性阻塞性肺病的临床疗效。方法计算机检索Pub Med、Ovid、CNKI、VIP、CBM、万方等数据库内有关沙美特罗/替卡松联用噻托溴铵,与单用沙美特罗/替卡松或单用噻托溴铵治疗中、重度慢性阻塞性肺病的随机对照研究,检索年限均为2000年1月至2015年5月,对纳入研究进行文献质量评价,采用Rev Man 5.2统计软件对同质性结果进行合并分析。结果共纳入文献15篇,其中13篇为中文,2篇为英文,合计2847例患者。Meta分析显示,联合用药对中、重度慢性阻塞性肺病患者肺功能、临床症状和生活质量的改善均优于单用沙美特罗/替卡松,除尚不能确定联合用药在降低PaCO_2优于单用噻托溴铵外,在肺功能、PaO_2和生活质量的改善也优于单用噻托溴铵。联合用药未增加不良反应的发生率,未加重不良反应的损害程度。结论沙美特罗/替卡松联用噻托溴铵治疗中、重度慢性阻塞性肺病是安全有效的,值得进一步推广。

Objective To evaluate lung functions and quality of life of patients treated with salmeterol/ticasone（ salmeterol/fluticasone propionate） combined with tiotropium in moderate to severe chronic obstructive pulmonary disease（ COPD）. Methods From PubMed,Ovid,CNKI,VIP,CBM and Wanfang database,data on randomized controlled trials（ RCT） about salmeterol/ticasone（ salmeterol/fluticasone propionate） combined with tiotropium or almeterol/ticasone（ salmeterol/fluticasone propionate） used alone or tiotropium used alone in treating moderate to severe COPD between January of 2000 and May of 2015 were retrieved and comprehensively evaluated. Meta-analysis of the included trials was performed using RevMan 5. 2 software. Results 15 RCTs were included,13 in Chinese,and 2 in English,involving 2847 patients. Meta-analysis showed that CUD was more effective than almeterol/ticasone（ salmeterol/fluticasone propionate） alone for moderate to severe COPD patients,and the difference was of statistical signficance. There was no statistical signficance between CUD and tiotropium alone in reducing PaCO2. At the same time,CUD did not increase the rate of adverse drug reactions（ ADRs） or the damage of ADRs. Conclusion The existing evidence shows that salmeterol/ticasone（ salmeterol/fluticasone propionate） combined with tiotropium is safe and effective for moderate to severe COPD paitents.