波生坦联合西地那非治疗肺动脉高压的Meta分析

Systematic review and Meta-analysis on the efficacy of bosentan combined with sildenafil in the treatment of pulmonary hypertension

目的系统评价在治疗单一药物控制不佳的肺动脉高压方面波生坦和西地那非联合使用在临床的疗效,为临床用药提供循证方面的参考。方法计算机检索维普(VIP)、万方(Wangfang data)、中国知网(CNKI)、Medline、PubMed、Embase、Cochrane图书馆和CBM。检索时间从建库至2019年4月1日。收集波生坦联合西地那非(观察组)对比其他两种药物联合组(对照组)治疗肺动脉高压疗效的文献。疗效指标包括:肺动脉压力、6分钟步行距离、呼吸困难指数。根据纳入和排除的标准,利用EndNote软件进行文献筛查,资料提取,并使用RevMan5. 3软件进行数据处理。结果最终纳入24项研究,共3114例患者,对照组和观察组的Meta分析结果显示波生坦联合西地那非(观察组)在改善肺动脉压力(WMD=-4. 65 mmHg,95%CI:-7. 52^-1. 78,P=0. 002)、降低呼吸困难指数(WMD=-0. 56,95%CI:-0. 83^-0. 29,P<0. 001)、提高6分钟步行距离(WMD=30. 08 m,95%CI:17. 26~42. 90,P<0. 001)方面均优于其他两种药物联合组(对照组)。结论波生坦联合西地那非治疗肺动脉高压效果显著。

OObbjjeeccttiivv e This study was designed to systematically review the efficacy of bosentan combined with sildenafil in the treatment of pulmonary hypertension in order to provide a reference for clinical medication in terms of evidence-based pharmacy. Methods Literatures in Medline,Embase,PubMed,Cochrane Library,Wanfang database,CNKI and VIP databases were searched and retrieved by computer from inception to April 1,2019. The data were collected on the efficacy of both bosentan combined with sildenafil(experimental group)and other drugs(control group)in the treatment of pulmonary arterial hypertension. Collected indicators included pulmonary artery pressure,6-minute walking distance,and dyspnea index. According to the inclusion and exclusion criteria,EndNote software was used for literature screening,data extraction,and RevMan5.3 was used for data processing. Results A total of 3114 patients were enrolled in 24 studies. Meta analysis showed:bosentan combined with sildenafil(observation group)in terms of reducing pulmonary artery pressure(WMD =-4.65 mmHg,95% CI:-7.52 ^-1.78,P = 0. 002),reducing dyspnea index(WMD =-0.56,95% CI:-0.83 ^-0.29,P < 0.001),and improving 6 minutes walking distance(WMD = 30.08 m,95% CI:17.26 ~ 42.90,P<0.001)were superior to the other two pulmonary hypertension drugs combined group(control group). Conclusion The efficacy of bosentan combined with sildenafil in the treatment of pulmonary hypertension was significant.