利奥西呱逆转肺动脉高压患者右心室重构及改善右心室功能的meta分析

Meta-Analysis of Riociguat reverse right ventricular remodeling and function in the patients with pulmonary hypertension

目的系统性评价利奥西呱对动脉性肺动脉高压及慢性血栓栓塞性肺动脉高压患者右心室重构及功能的影响。方法检索Embase、PubMed、Cochrane Library、中国知网、万方医学网等数据库中利奥西呱逆转肺动脉高压患者右心室重构及改善右心室功能的相关文献,由2名研究人员独立进行文献质量评价,提取资料后应用RevMan5.3软件进行meta分析。结果共纳入非随机对照试验5项,其中前瞻性观察性研究3项,回顾性研究2项,共186例患者。利奥西呱可明显增加肺动脉高压患者6min步行距离,改善血流动力学。患者服用利奥西呱后右心房面积、右心室基底直径均缩小,右心室面积变化分数、三尖瓣环收缩期位移均增加,差异均有统计学意义(P<0.05)。结论利奥西呱可改善动脉性肺动脉高压及慢性血栓栓塞性肺动脉高压患者的血流动力学,逆转患者右心室重构,改善右心室功能。但尚需更多大样本,随机对照研究进一步验证利奥西呱对患者右心室重构及功能的影响。

Objective To evaluate the effect of Riociguat on the right ventricular remodeling and function in the patients with pulmonary arterial hypertension(PAH)and chronic thromboembolic pulmonary hypertension(CTEPH).Methods Embase,PubMed,Cochrane Library,China national knowledge infrastructure(CNKI)and Wanfang databases were searched,to collect the relevant studies of right ventricular remodeling and right ventricular function of pulmonary hypertension by Riociguat reversal.The quality evaluation was performed independently by two reviewers.After the data extraction,the meta analysis was performed by using the RevMan5.3software.Results A total of five non-randomized controlled trials involving 186patients were included,including three prospective observational studies and two retrospective studies.The meta-analysis showed that Riociguat could significantly increase 6-minutes walking distance and improve pulmonary hemodynamics.In addition,after taking Riociguat,the right atrium area and right ventricle basal diameter reduced,right ventricular fractional area change and tricuspid annular plane systolic excursion increased,the differences were statistically significant(P<0.01).Conclusion Riociguat can improve the pulmonary hemodynamics,reverse right ventricular remodeling and improve the right ventricular function in the patients with PAH and CTEPH.However,more randomized controlled studies with large samples are needed to further verify the effect of Riociguat on the right ventricular remodeling and function.