非前列腺素类前列环素受体激动剂治疗肺动脉高压的疗效和安全性:荟萃分析

IF 3.3 3区医学 Q2 PHARMACOLOGY & PHARMACY

Pulmonary pharmacology & therapeutics Pub Date : 2023-02-01 DOI:10.1016/j.pupt.2022.102182

Pengwei Wang , Hongyan Feng , Yongli Guo , Nan Wu , Honglei Yin , Yongxiang Zhang , Sujuan Pei , Jianlian Gao , Yizhong Lu , Yang Hu , Yongheng Zhang , Zhijian Deng

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引用次数: 0

摘要

背景:许多国家推荐口服非前列腺素类前列环素受体激动剂治疗肺动脉高压。目的评价非前列腺素类前列环素受体激动剂对肺动脉高压的特异性影响，探讨研究特点对结果的影响。方法系统检索spubmed、Embase和ClinicalTrials.gov网站自成立至2022年7月12日。随机对照试验比较非前列腺素类前列环素受体激动剂和安慰剂治疗肺动脉高压。两位研究者独立选择符合条件的研究，评估偏倚风险并提取相关数据。使用RevMan5.1对入组研究进行统计分析和偏倚风险评估。普洛斯彼罗注册号码CRD42022304172。结果纳入7项试验，共1727例患者。汇总分析显示，非前列腺素类前列环素受体激动剂可显著降低临床恶化事件(风险比[RR]， 0.63;95%可信区间[CI]， 0.54 ~ 0.74)，增加6分钟步行距离(平均差值[MD]， 10 m;95% CI, 3-17 m)，肺血管阻力降低(MD， - 121 dyn s/cm5;95% CI，−172 ~−69 dyn s/cm5)和心脏指数升高(MD, 0.38 L/min/m2;95% CI, 0.26 ~ 0.50 L/min/m2)。全因死亡率无显著差异(RR, 0.86;95% CI, 0.26 ~ 2.78)， NYHA/WHO功能分类(RR, 1.16;95% CI, 0.61 ~ 2.18)，平均肺动脉压(MD，−0.88 mmHg;95% CI，−2.20 ~ 0.44 mmHg)，右房压(MD, 0.66 mmHg;95% CI，−0.59 ~ 1.90 mmHg)和总不良事件(RR, 1.05;非前列腺素类前列环素受体激动剂组与对照组之间的95% CI为0.99 ~ 1.10。结论非前列腺素类前列环素受体激动剂治疗对肺动脉高压患者的临床恶化、肺血管阻力和心脏指数有改善作用，但未增加总不良事件的发生率。

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Efficacy and safety of non-prostanoid prostacyclin receptor agonist for pulmonary hypertension: A meta-analysis

Background

Oral non-prostanoid prostacyclin receptor agonists therapies have been recommended for pulmonary arterial hypertension in many countries.

Objective

We aimed to evaluate the specific impact of non-prostanoid prostacyclin receptor agonists on pulmonary hypertension and to explore the influence of study characteristics on results.

Methods

PubMed, Embase, and ClinicalTrials.gov were systematically searched from inception to July 12, 2022. Randomized controlled trials comparing non-prostanoid prostacyclin receptor agonists administration with placebo for treating pulmonary hypertension were included. Two researchers independently selected eligible studies, assessed the bias risk and extracted related data. RevMan5.1 was used for performing the statistical analysis and the assessment of bias risk of the enrolled studies. PROSPERO registered number CRD42022304172.

Results

Seven trials involving 1727 patients were included. Pooled analyses indicated non-prostanoid prostacyclin receptor agonists significantly reduced clinical worsening events (risk ratio [RR], 0.63; 95% confidence interval [CI], 0.54 to 0.74), increased 6-min walk distance (mean difference [MD], 10 m; 95% CI, 3–17 m), decreased pulmonary vascular resistance (MD, −121 dyn s/cm⁵; 95% CI, −172 to −69 dyn s/cm⁵) and increased cardiac index (MD, 0.38 L/min/m²; 95% CI, 0.26–0.50 L/min/m²) compared with the control. No significant differences in all-cause mortality (RR, 0.86; 95% CI, 0.26 to 2.78), NYHA/WHO functional class (RR, 1.16; 95% CI, 0.61 to 2.18), mean pulmonary artery pressure (MD, −0.88 mmHg; 95% CI, −2.20 to 0.44 mmHg), right atrial pressure (MD, 0.66 mmHg; 95% CI, −0.59 to 1.90 mmHg) and total adverse events (RR, 1.05; 95% CI, 0.99 to 1.10) were found between non-prostanoid prostacyclin receptor agonists group and control group.

Conclusion

Non-prostanoid prostacyclin receptor agonists treatment exerted benefits on clinical worsening, pulmonary vascular resistance, and cardiac index in pulmonary hypertension patients, without increasing the incidence of total adverse events.

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来源期刊

Pulmonary pharmacology & therapeutics 医学-呼吸系统

CiteScore

6.20

自引率

0.00%

发文量

审稿时长

42 days

期刊介绍： Pulmonary Pharmacology and Therapeutics (formerly Pulmonary Pharmacology) is concerned with lung pharmacology from molecular to clinical aspects. The subject matter encompasses the major diseases of the lung including asthma, cystic fibrosis, pulmonary circulation, ARDS, carcinoma, bronchitis, emphysema and drug delivery. Laboratory and clinical research on man and animals will be considered including studies related to chemotherapy of cancer, tuberculosis and infection. In addition to original research papers the journal will include review articles and book reviews. Research Areas Include: • All major diseases of the lung • Physiology • Pathology • Drug delivery • Metabolism • Pulmonary Toxicology.