靶向药物治疗特发性肺动脉高压的有效性和安全性meta分析

Meta-analysis of the efficacy and safety of targeted drug therapy in idiopathic pulmonary arterial hypertension

目的评价肺动脉高压靶向药物治疗特发性肺动脉高压(IPAH)的有效性和安全性。方法2名研究者检索中、英文文献,根据纳入及排除标准选择文献、提取数据及评价文献质量,采用STATA15.1统计软件对效应值进行meta分析。结果共纳入2项随机对照研究和16项前瞻性队列研究,接受靶向治疗465例,对照组61例。靶向治疗患者全因死亡率为5.1%,对照组为18.0%。前列环素类似物组不良事件退出率为1.8%,波生坦组为2.7%。波生坦和前列环素类似物靶向药物治疗能明显改善IPAH患者6 min步行距离。波生坦能降低肺血管阻力和平均肺动脉压力,前列环素类似物对肺循环血流动力学指标的影响需更多研究数据。结论靶向药物为IPAH的安全药物,能降低IPAH患者的短期全因死亡率。波生坦能改善运动耐量及肺循环血流动力学指标,磷酸二酯酶5抑制剂类及前列环素类似物类靶向药物的有效性须进一步研究。

Objective A meta-analysis was conducted to study the efficacy and safety of targeted drug therapy for patients with idiopathic pulmonary arterial hypertension(IPAH).Methods Two researchers searched English databases(PubMed,Cochrane Library,Embase)and Chinese databases(CNKI,VIP,WanFang Data and CBM)independently.Extracted data and conducted the quality assessment,the meta-analysis was performed by Stata15.1.Results In total,2 randomized controlled trials(RCT)and 16 prospective cohort studies(Pro),465 patients with target therapy and 61 patients in the control group included in the 2 RCTs were included.The mortality of patients receiving targeted therapy was 5.1%,and that of the control group was 18.0%.The rate of withdrawal due to adverse effects in ProsA group was 1.8%,and the rate of Bosentan was 2.7%.Targeted therapy of Bosontan and ProsA could improve 6-minutes walk distance(6MWD).Bosontan reduced pulmonary vascular resistance(PVR)and mean pulmonary artery pressure(mPAP).The effect of ProsA with pulmonary circulatory hemodynamics needs more data.Conclusion The targeted drugs are safety for IPAH,it can reduce all-cause mortality of IPAH in short-term.Bosentan can improve the exercise tolerance and pulmonary circulation hemodynamics,and the effectiveness of PDE-5i and ProsA needs further study.