不同药物治疗下肢动脉硬化闭塞症伴间歇性跛行有效性和安全性的网状Meta分析

Efficacy and safety of different drugs for the treatment of intermittent claudication due to peripheral arterial disease: a network meta-analysis

目的 系统评价不同药物治疗下肢动脉硬化闭塞症伴间歇性跛行的有效性和安全性。方法 计算机检索PubMed、Scopus、EMbase、The Cochrane Library、Web of Science、CNKI、WanFang Data和VIP数据库,搜集不同药物治疗间歇性跛行患者的随机对照试验,检索时限均从建库至2021年12月31日。由2位评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用Stata 16.0软件进行网状Meta分析。结果 共纳入36个研究,涉及西洛他唑等扩血管药物,阿托伐他汀等降脂药物,沙格雷酯等抗血小板聚集药物及左旋肉碱、别嘌呤醇等其他类型药物。Meta分析结果显示:辛伐他汀、苄环烷、雷米普利改善无痛步行距离效果优于西洛他唑等药物(P<0.05),其中苄环烷的疗效最为突出,同时辛伐他汀、雷米普利在最大步行距离的改善方面同样优于西洛他唑等药物(P<0.05),而西洛他唑与其他药物的疗效均无统计学差异(P>0.05);在不良反应方面,伊洛前列素的安全性劣于其他药物,而舒洛地特的耐受性最好。结论 现有证据显示苄环烷是改善下肢动脉硬化闭塞症间歇性跛行患者无痛步行距离较好的药物,辛伐他汀、雷米普利是改善最大步行距离较好的药物,但以上药物安全性均较差。综合而言,舒洛地特和左旋肉碱可能是治疗间歇性跛行较为理想的药物。受纳入研究数量和质量限制,上述结论尚需开展更多高质量研究予以验证。

Objective To systematically review the efficacy and safety of different drugs for the treatment of intermittent claudication in patients with peripheral arterial disease. Methods The PubMed, Scopus, EMbase, The Cochrane Library, Web of Science, CNKI, WanFang Data and VIP databases were searched to collect randomized controlled trials(RCTs) of intermittent claudication due to peripheral arterial disease from database inception to December 31st, 2021. Two researchers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. Network meta-analysis was then performed using Stata 16.0 software. Results A total of 36 studies were included, which involved vasodilators(i.e., cilostazol), lipid-lowering agents(i.e., atorvastatin), antiplatelet drugs(i.e.,sarpogrelate), and other types of medicine(i.e., L-carnitine and allopurinol). The results of meta-analysis showed that the effects of simvastatin, bencyclane, and ramipril were superior to cilostazol and other drugs in improving PFWD, among which bencyclane was the most efficient. Besides, simvastatin and ramipril were also superior to cilostazol and other drugs in improving MWD(P<0.05). However, there was no statistically significant difference between cilostazol and other drugs(P>0.05). In terms of adverse events, iloprost was inferior to other drugs, while sulodexide was better tolerated.Conclusion Bencyclane is a preferred choice to improve PFWD for the treatment of IC due to PAD, simvastatin and ramipril to improve MWD;however, their safety is poor. Overall, sulodexide and L-carnitine are ideal medicines for IC.Due to the limited quality and quantity of the included studies, more high-quality studies are needed to verify the above conclusion.