不同扩血管药物治疗间歇性跛行疗效与安全性的系统评价和网状meta分析

Systematic evaluation and network meta analysis of efficacy and safety of different vasodilators for treating intermittent claudication

目的系统评价西洛他唑、己酮可可碱和贝前列素钠治疗间歇性跛行的疗效和安全性。方法计算机检索Pubmed、Scopus、Web of Science、Embase、中国知网、万方和维普数据库,搜集西洛他唑、己酮可可碱和贝前列素钠治疗下肢动脉硬化闭塞症(PAD)的随机对照试验,检索时间为建库至2021年12月。由研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用Stata16.0进行网状meta分析。结果共纳入30项研究,其中西洛他唑18项,己酮可可碱12项,贝前列素钠5项,结果显示在无痛步行距离方面,西洛他唑比己酮可可碱和贝前列素钠分别增加了8.76 m和4.15 m(P>0.05),而贝前列素钠比己酮可可碱增加了4.61 m(P>0.05);在最大步行距离方面,西洛他唑对比己酮可可碱和贝前列素钠分别增加了28.28 m和19.03 m(P>0.05),而贝前列素钠比己酮可可碱增加了9.25 m(P>0.05);在踝肱指数方面,贝前列素钠和西洛他唑增加0.18和0.06(P<0.05),而己酮可可碱的疗效不明显(P>0.05);在安全性方面,西洛他唑和己酮可可碱相当,对患者的耐受性均好于贝前列素钠(P<0.05)。结论西洛他唑可能是目前治疗间歇性跛行最合适的扩血管药物。

Objective To systematically evaluate the efficacy and safety of cilostazol,pentoxifylline and beraprost sodium for treating intermittent claudication.Methods The randomized controlled trials(RCTS)on cilostazol,pentoxifylline and beraprost sodium for treating peripheral arterial disease(PAD)were retrieved from Pubmed,Scopus,Web of Science,Embase,CNKI,Wanfang and VIP databases by computer.The retrieval time limit was from their databases establishment to December 2021.The researchers independently screened the literature,extracted the data,and evaluated the risk of bias in the included studies.A network meta analysis was performed by using Stata 16.0.Results A total of 30 studies were included,including 17 studies for cilostazol,12 studies for pentoxifylline and 5 studies for beraprost sodium.The results showed that in terms of painfree walking distance,cilostazol increased by 8.76 m and 4.15 m compared with beraprost and pentoxifylline(P>0.05),while beraprost sodium increased by 4.61 m compared with pentoxifylline(P>0.05);in terms of maximum walking distance,cilostazol increased by 28.28 m and 19.03 m compared with pentoxifylline and beraprost(P>0.05),while beraprost sodium increased by 9.25 m compared with pentoxifylline(P>0.05);in terms of ankle brachial index,beraprost and cilostazol increased by 0.18 m and 0.06 m on average(P<0.05),while pentoxifylline had no significant effect(P>0.05);in terms of safety,cilostazole was comparable to pentotheobromine,and their tolerance for the patients were better than beraprost.Conclusion Cilostazol may be the most suitable vasodilator for the treatment of intermittent claudication.