【摘要】 目的系统评价曲前列尼尔治疗肺动脉高压的有效性与安全性。方法计算机检索PubMed、EMbase、The Cochrane Library(2015年2期)、CBM、WanFang Data和CNKI数据库,搜集有关曲前列尼尔治疗肺动脉高压的随机对照试验(RCT),检索时限均为建库至2015年5月1日。由2位研究者独立筛选文献、提取资料和评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果共纳入7个RCT,1 662例患者。Meta分析结果显示,曲前列尼尔组与对照组相比,显著增加肺动脉高压患者的6分钟步行距离[MD=19.62,95%CI(0.55,38.69),P=0.04],降低患者的Brog评分[MD=–0.52,95%CI(–0.96,–0.07),P=0.02],提高患者的心脏指数[MD=0.19,95%CI(0.08,0.30),P=0.000 6],降低肺循环阻力[MD=–3.23,95%CI(–4.80,–1.66),P<0.000 1]。但两组在病死率和临床恶化率方面,差异均无统计学意义。结论曲前列尼尔能明显改善肺动脉高压患者的运动能力、呼吸功能和心功能,降低肺循环阻力,但不能有效降低肺动脉高压患者的病死率和临床恶化率。更多还原

【Abstract】 Objective To systematically review the efficacy and safety of treprostinil for patients with pulmonary arterial hypertension(PAH).Methods Databases including PubMed,EMbase,The Cochrane Library(Issue 2,2015),WanFang Data,CBM and CNKI were searched to collect randomized controlled trials(RCTs) about treprostinil for PAH from inception to 1st May 2015.Two reviewers independently screened literature,extracted data,and assessed the risk of bias of included studies.Then,meta-analysis was performed using RevMan 5.3 software.Results A total of seven RCTs including 1 662 participants were finally included.The results of meta-analysis showed that,compared with placebo,treprostinil could increase patients’ 6-min walk distance(MD=19.62,95%CI 0.55 to 38.69,P=0.63),reduce Brog score(MD=-0.52,95%CI-0.96 to-0.07,P=0.06),decrease pulmonary vascular resistance(MD=-3.23,95%CI-4.80 to-1.66,P=0.42) and improve cardiac index(MD=0.19,95%CI 0.08 to 0.30,P=0.44),but there were no significant differences between two groups in incidence of mortality(OR=0.84,95%CI 0.47 to 1.50,P=0.82) and clinical deterioration(OR=0.84,95%CI 0.56 to 1.26,P=0.95).Conclusion Current evidence reveals that treprostinil can improve excise capacity,respiratory function and ameliorate hemodynamic index,but can’t reduce the incidence of mortality and clinical deterioration in patients with PAH.更多还原