他汀类药物治疗慢性阻塞性肺疾病合并肺动脉高压的Meta分析

摘要

Objective To evaluate the effects of statin treatment combined with conventional therapy in patients with chronic obstructive pulmonary disease (COPD) and pulmonary hypertension(PH) . Methods Literatures published were searched completely in the databases including PubMed.CBM, VIP and WANGFANG to collect the randomized control trials(RCTs ) of statin combined with the conventional treatment versus the conventional treatment on patients with stable COPD. The studies were evaluated and screened strictly according to the inclusive and exclusive criteria. And meta - analysis was conducted by RevMan 5. 0 software. Results Seven RCTs were included and 467 patients with stable COPD and PH met inclusion criterion. The meta-analysis showed that,compared with control group, a)the statin therapy could lower mean pulmonary artery pressure(mPAP) [MD= -3. 83 mmHg,95%CI( - 5. 22, -2. 43)] as well as pulmonary arterial systolic pressure(PASP)[MD= -5. 66 mmHg,95%CI( - 7. 15,-4. 16)] significantly in patients;b)the statin treatment could excessively reduce endothelin-(ET-1) [MD= - 3. 51 pg/ml,95 %CI( - 4. 77, -2. 55)],and improve the value of nitric oxide(NO) in blood [SMD=1. 06umol/l,95%CJ(0. 81,1. 31)]; and c)the statin therapy could improve FEV, %[SMD=9. 79,95%CK6. 05,13. 52)]. Conclusion The use of statins in the stable COPD patients combined with PH can excessively lower the pulmonary hypertension, improve pulmonary function as well as clinical effectiveness.%目的 系统评价他汀类药物(statins)治疗慢性阻塞性肺疾病(COPD)合并肺动脉高压(PH)的临床疗效.方法 系统检索PubMed、CBM、维普、万方等数据库,全面收集他汀类药物治疗慢性阻塞性肺疾病合并肺动脉高压的随机对照试验(RCT).按纳入排除标准筛选文献、提取资料和进行方法学质量评价,并采用RevMan 5.0软件进行Meta分析.结果 共纳入7个RCT,共计467例患者.包括2个安慰剂对照试验和5个非安慰剂对照试验.Meta分析结果显示:①statin能改善患者平均肺动脉压(mPAP)值[MD=-3.83 mmHg,95％ CI(-5.22,-2.43)],肺动脉收缩压(PASP)值[MD=-5.66 mmHg,95％CI(-7.15,-4.16)],与对照组比较,差异有统计学意义.②statin能显著降低患者内皮素-1(ET-1)值[MD=-3.51 pg/ml,95％ CI(-4.77,-2.55)]、增高一氧化氮(NO)值[SMD=1.06,95％ CI(0.81,1.31)],与对照组相比,差异有统计学意义.③statin能改善患者第一秒用力呼气量占预计值的百分比(FEV1％)[MD=9.79,95％CI(6.05,13.52)].结论 他汀类药物应用于COPD合并PH患者能显著改善患者的肺动脉压,改善肺功能,提高临床疗效.