乙酰唑胺治疗慢性高原病的疗效与安全性的Meta分析

Efficacy and safety of acetazolamide in the treatment of chronic mountain sickness:a meta-analysis

目的系统评价乙酰唑胺(ACZ)治疗慢性高原病的疗效与安全性。方法计算机检索PubMed、EMbase、CoChcrane Library、中国知网(CNKI)、万方数据库、维普等数据库,检索时限为建库至2019年12月。收集相关ACZ治疗慢性高原病的随机对照试验(RCTs)文献,根据Cocharane偏倚风险评价工具对纳入文献进行质量评价,设计数据提取表,数据提取、转化、核查、修改。采用Review Manager 5.3软件对数据进行Meta分析。结果初步检索获得文献301篇(英文294篇,中文7篇),经过EndNote软件去除重复文献113篇,通过阅读文题和摘要排除不符合纳入标准的文献161篇,经过阅读全文、剔除数据不全文献,最终纳入4篇文献(英文4篇,中文0篇),纳入的总样本数147例,其中实验组82例,对照组65例。Meta分析结果显示:ACZ 250 mg治疗慢性高原病,可以降低HCT(mean difference=-2.91;95%CI:-4.55^-1.28;P<0.001)、降低PCO2(mean difference=-4.60;95%CI:-5.88^-3.33;P<0.001)、升高PO2(mean difference=2.39;95%CI:0.99~3.80;P<0.001),与安慰剂组比较差异有统计学意义;降低CMS评分,但与安慰剂组比较差异无统计学意义(mean difference=-0.27;95%CI:-2.52~1.99;P>0.05)。ACZ 250 mg与ACZ 500 mg治疗慢性高原病均可提升PO2、降低PCO2,但两者比较差异无统计学意义(mean difference=-0.41;95%CI:-2.75~1.94;P>0.05)。ACZ治疗慢性高原病过程中不良反应轻微。结论 ACZ 250 mg治疗慢性高原病能降低红细胞数量,提高氧合,疗效明显;ACZ 250 mg与ACZ 500 mg治疗慢性高原病,疗效无差异;ACZ治疗慢性高原病不良反应少,安全可靠。

Objective To evaluate the efficacy and safety of acetazolamine in the treatment of chronic hyperplasia. Methods Articles published before Dec., 2019 were searched from PubMed, EMbase, CoChrrane Library, China Knowledge Network(CNKI), Wanfang database, VIP, and other databases, and the randomized controlled trials(RCTs) related to acetazolamine in the treatment of chronic hyperplasia were collected. Review Manager 5.3 software was used to perform meta-analysis. Results A total of 301 literatures(294 English literatures and 7 Chinese literatures)were obtained, of which 113 duplicate literatures were removed by EndNote software, 161 articles that did not meet the inclusion criteria were excluded by reading questions and abstracts, and 4 literatures(4 English literatures, 0 Chinese literatures) were finally included by reading the full text and eliminating incomplete data. The 4 literatures involved 147 cases, including 82 cases in the experimental group and 65 cases in the control group. Meta-analysis showed that acetazolamide 250 mg in the treatment of chronic high altitude disease can reduce HCT(mean difference=-2.91;95%CI:-4.55 to-1.28;P<0.001), decrease PCO2(mean difference=-4.60;95%CI:-5.88 to-3.33;P<0.001), increase PO2(mean difference=2.39;95% CI: 0.99 to 3.80;P<0.001), and slightly decrease CMS score(mean difference=-0.27;95% CI:-2.52 to1.99;P>0.05, with no significant difference with the control group). The results of acetazolamide 250 mg and acetazolamide 500 mg in the treatment of chronic high altitude disease were similar(mean difference=-0.41;95% CI:-2.75 to1.94;P>0.05). Acetazolamide was safe during treatment of chronic high altitude disease. Conclusion Acetylzolamine250 mg is effective in the treatment of chronic high altitude disease, which can reduce the number of red blood cells and increase oxygenation. There was no difference in the clinical effects between acazolamide 250 mg and acetazolamide500 mg for the treatment of chronic high altitude disease. Acetazolamide was safe and reliable in the treatment of chronic high altitude disease.