前列地尔脂微球载体制剂治疗慢性肺源性心脏病的Meta分析

Lipo-PGE1 for Chronic Cor Pulmonale:a Meta-Analysis

目的系统评价前列地尔脂微球载体制剂(lipo-PGE1)治疗慢性肺源性心脏病(肺心病)的临床疗效。方法检索PubMed、Cochrane Library、CBM、WANFANG DATA、维普和CNKI数据库,查找lipo-PGE1治疗肺心病的随机对照临床试验(RCTs),检索时间为建库至2018年9月,由2名研究者独立筛选文献,对纳入的RCTs采用改良Jadad量表进行质量评价后,采用RevMan 5.3软件进行Meta分析。结果共纳入28个研究、2367例患者。Meta分析显示,与常规治疗相比,lipo-PGE1联合常规治疗可降低肺心病患者的肺动脉收缩压、肺动脉舒张压、平均肺动脉压、动脉血二氧化碳分压、纤维蛋白原、全血高切黏度、全血低切黏度,改善动脉血氧分压、第1秒用力呼气容积、第1秒用力呼气量占用力肺活量比值、6 min步行试验,并能提高治疗的有效率(均P<0.05)。治疗期间,患者均未见严重不良反应。结论在肺心病的常规治疗上加用lipo-PGE1,可明显改善其临床疗效。但受纳入研究质量的限制,尚需开展更多高质量的研究予以验证。

Objective To systematically evaluate the clinical efficacy of prostaglandin E1 incorporated in lipid microspheres(lipo-PGE1)in treating chronic cor pulmonale.Methods Databases including PubMed,Cochrane Library,CBM,CNKI,VIP and WANFANG were searched for randomized controlled trials(RCTs)about the treatment of chronic cor pulmonale with lipo-PGE1 from their inception to September 2018.Two reviewers independently screened literature according to the inclusion and exclusion criteria.The quality of RCTs was assessed using the improved Jadad scale,and then meta-analysis was performed using RevMan 5.3 soft ware.Results A total of 28 RCTs involving 2367 patients were included.The meta-analysis showed that,compared with conventional treatment,lipo-PGE1 could significantly reduce pulmonary artery systolic pressure,pulmonary artery diastolic pressure,mean pulmonary artery pressure,PaCO 2,fibrinogen level,high-shear blood viscosity,low-shear blood viscosity,improved PaO 2,forced expiratory volume in one second,ratio of one-second forced expiratory volume to forced vital capacity and 6-minute walk test,and obviously improved the clinical efficacy(P<0.05).No severe adverse reactions occurred in all patients.Conclusion Lipo-PGE1 can significantly improve the clinical effect on chronic cor pulmonale based on the conventional treatment.However,more high-quality RCTs need to be conducted to confirm the conclusion due to the limited quality of the included studies.