阿奇霉素联合辛伐他汀治疗慢性阻塞性肺疾病合并肺动脉高压临床疗效的Meta分析

摘要

Objective To evaluate the clinical effect of azithromycin combined with simvastatin in treating COPD patients merged with pulmonary arterial hypertension. Methods We searched PubMed, Medline, CNKI, VIP and WanFang Data to collect pertinent literatures about clinical effect of azithromycin combined with simvastatin in treating COPD patients merged with pulmonary arterial hypertension from creating database to March 2017. Patients in control group received simvastatin, while patients in test group received azithromycin combined with simvastatin; RevMan 5.3.0 software was used to carry out the Meta-analysis. Results A total of 9 literatures (all were Chinese) were involved at last, including 776 patients. Meta-analysis results showed that, FVC 〔MD=0.39, 95%CI (0.36, 0.41), P<0.000 01〕 and FEV1〔MD=0.35, 95%CI (0.23, 0.47), P<0.000 01〕 in test group were statistically significantly larger than those in control group after treatment, PaO2〔MD=8.32, 95%CI (7.37, 9.26), P<0.000 01〕 and SaO2〔MD=3.82, 95% CI (3.17, 4.48), P<0.000 01〕 in test group were statistically significantly higher than those in control group after treatment, pulmonary arterial systolic pressure 〔MD=-1.00, 95%CI (-1.30, -0.71), P<0.000 01〕, pulmonary artery dystolic pressure 〔MD=-1.37, 95%CI (-1.49, -1.25), P<0.000 01〕 and CRP 〔MD=-8.33, 95%CI (-9.91,-6.74), P<0.000 01〕in test group were statistically significantly lower than those in control group after treatment, while 6-minute walking distance in test group was statistically significantly longer than that in control group after treatment 〔MD=75.78, 95%CI (70.85, 80.72), P<0.000 01)〕. Conclusion Based on existing literature evidence, azithromycin combined with simvastatin can effectively improve the cardio-pulmonary function, adjust the arterial blood-gas analysis index, reduce the pulmonary arterial pressure and inflammatory reaction in treating COPD patients merged with pulmonary arterial hypertension.%目的 评价阿奇霉素联合辛伐他汀治疗慢性阻塞性肺疾病(COPD)合并肺动脉高压(PAH)的临床疗效.方法 计算机检索PubMed、Medline、中国知网(CNKI)、维普网(VIP)及万方数据知识服务平台等数据库,筛选关于阿奇霉素联合辛伐他汀治疗COPD合并PAH临床疗效的相关文献,检索时间为建库至2017年3月.对照组患者采用辛伐他汀治疗,试验组患者采用阿奇霉素联合辛伐他汀治疗;采用RevMan 5.3.0软件进行Meta分析.结果 最终纳入9篇文献,均为中文文献,包括776例患者.Meta分析结果显示,试验组患者治疗后用力肺活量〔MD=0.39, 95%CI(0.36,0.41),P<0.00001〕和第1秒用力呼气容积〔MD=0.35,95%CI(0.23,0.47),P<0.00001〕大于对照组,治疗后动脉血氧分压〔MD=8.32,95%CI(7.37,9.26),P<0.00001〕和动脉血氧饱和度〔MD=3.82,95%CI(3.17, 4.48),P<0.00001〕高于对照组,治疗后肺动脉收缩压〔MD=-1.00,95%CI(-1.30,-0.71),P<0.00001〕、肺动脉舒张压〔MD=-1.37,95%CI(-1.49,-1.25),P<0.00001〕及C反应蛋白〔MD=-8.33,95%CI(-9.91,-6.74), P<0.00001〕低于对照组,治疗后6分钟步行距离〔MD=75.78,95%CI(70.85,80.72),P<0.00001)〕长于对照组.结论 现有文献证据表明,阿奇霉素联合辛伐他汀能有效改善COPD合并PAH患者心肺功能、动脉血气,降低肺动脉压力,减轻炎性反应.