{"title":"血管扩张剂对慢性阻塞性肺病的疗效：系统回顾和荟萃分析。","authors":"Ningxin Han, Hui Qi, Yujie Yin, Yi Liu, Peipei Jin, Yunlong Hou, Zhenhua Jia","doi":"10.1097/MD.0000000000039794","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Chronic obstructive pulmonary disease (COPD) is a complex progressive disease. Some vasodilators have been reported with therapeutic potential to protect vascular function therefore may delay the progression of COPD.</p><p><strong>Methods: </strong>We searched PubMed, Embase, Cochrane Library, Web of Science, OVID and Clinicaltrials.gov database for eligible randomized controlled trials (RCTs) published before January 1, 2024. RCTs which treatment with vasodilators to COPD patients were included. Gas-blood exchange indicators were the primary outcomes, and ventilation function and quality of life indicators were the secondary outcomes. Mean differences with 95% confidence intervals were extracted. Subgroup analysis of vasodilator category and COPD complicated with or without pulmonary hypertension (PH) were performed. The risk of bias was assessed using Cochrane risk of bias tool, and the meta-analysis was conducted.</p><p><strong>Results: </strong>Twenty studies with a total sample size of 986 were included. The results showed that the 2 types of drugs in vasodilators included PDE-5 inhibitors could improve DLCO (MD = 6.56 [95% CI (1.74, 11.39)], P = .008) and iNO could reduce PaCO2 (MD = -0.10 [95% CI (-0.17, -0.03)], P = .006). Vasodilators could reduce PaCO2 in COPD complicated with PH (COPD-PH) (MD = -0.10 [95% CI (-0.17, -0.03)], P = .006). There were no statistically significant differences in FEV1 (MD = 0.02 [95% CI (-0.11, 0.16)], P = .74), FEV1% predicted (MD = 0.07 [95% CI (-1.90, 2.05)], P = .94), FEV1/FVC (MD = 0.70 [95% CI (-4.02, 5.42)], P = .77) and VE/VCO2 (MD = -0.17 [95% CI (-2.39, 2.05)], P = .88) levels. The total SGRQ score was significantly lower in vasodilator groups (MD = -5.53 [95% CI (-9.81, -1.24)], P = .01).</p><p><strong>Conclusions: </strong>The therapeutic effects of vasodilators for COPD are controversial. In this meta-analysis, vasodilators have benefits in improving gas-blood exchange function and quality of life in COPD patients. 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Some vasodilators have been reported with therapeutic potential to protect vascular function therefore may delay the progression of COPD.</p><p><strong>Methods: </strong>We searched PubMed, Embase, Cochrane Library, Web of Science, OVID and Clinicaltrials.gov database for eligible randomized controlled trials (RCTs) published before January 1, 2024. RCTs which treatment with vasodilators to COPD patients were included. Gas-blood exchange indicators were the primary outcomes, and ventilation function and quality of life indicators were the secondary outcomes. Mean differences with 95% confidence intervals were extracted. Subgroup analysis of vasodilator category and COPD complicated with or without pulmonary hypertension (PH) were performed. The risk of bias was assessed using Cochrane risk of bias tool, and the meta-analysis was conducted.</p><p><strong>Results: </strong>Twenty studies with a total sample size of 986 were included. The results showed that the 2 types of drugs in vasodilators included PDE-5 inhibitors could improve DLCO (MD = 6.56 [95% CI (1.74, 11.39)], P = .008) and iNO could reduce PaCO2 (MD = -0.10 [95% CI (-0.17, -0.03)], P = .006). Vasodilators could reduce PaCO2 in COPD complicated with PH (COPD-PH) (MD = -0.10 [95% CI (-0.17, -0.03)], P = .006). There were no statistically significant differences in FEV1 (MD = 0.02 [95% CI (-0.11, 0.16)], P = .74), FEV1% predicted (MD = 0.07 [95% CI (-1.90, 2.05)], P = .94), FEV1/FVC (MD = 0.70 [95% CI (-4.02, 5.42)], P = .77) and VE/VCO2 (MD = -0.17 [95% CI (-2.39, 2.05)], P = .88) levels. The total SGRQ score was significantly lower in vasodilator groups (MD = -5.53 [95% CI (-9.81, -1.24)], P = .01).</p><p><strong>Conclusions: </strong>The therapeutic effects of vasodilators for COPD are controversial. In this meta-analysis, vasodilators have benefits in improving gas-blood exchange function and quality of life in COPD patients. 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引用次数: 0
摘要
背景：慢性阻塞性肺疾病（COPD）是一种复杂的进行性疾病。据报道，一些血管扩张剂具有保护血管功能的治疗潜力，因此可延缓慢性阻塞性肺病的进展：我们在 PubMed、Embase、Cochrane Library、Web of Science、OVID 和 Clinicaltrials.gov 数据库中检索了 2024 年 1 月 1 日之前发表的符合条件的随机对照试验（RCT）。其中包括对慢性阻塞性肺病患者使用血管扩张剂治疗的 RCT。气血交换指标为主要结果，通气功能和生活质量指标为次要结果。研究提取了平均差异和 95% 的置信区间。对血管扩张剂类别和合并或不合并肺动脉高压（PH）的慢性阻塞性肺病患者进行了分组分析。使用Cochrane偏倚风险工具评估偏倚风险，并进行荟萃分析：结果：共纳入 20 项研究，样本量共计 986 个。结果显示，血管扩张剂中的 2 种药物（包括 PDE-5 抑制剂）可改善 DLCO（MD = 6.56 [95% CI (1.74, 11.39)]，P = .008），iNO 可降低 PaCO2（MD = -0.10 [95% CI (-0.17, -0.03)]，P = .006）。血管扩张剂可降低 COPD 合并 PH（COPD-PH）患者的 PaCO2（MD = -0.10 [95% CI (-0.17, -0.03)]，P = .006）。在 FEV1（MD = 0.02 [95% CI (-0.11, 0.16)]，P = .74）、FEV1% 预测值（MD = 0.07 [95% CI (-1. 90, 2.05)]，P = .74）方面，差异无统计学意义。90, 2.05)], P = .94), FEV1/FVC (MD = 0.70 [95% CI (-4.02, 5.42)], P = .77) 和 VE/VCO2 (MD = -0.17 [95% CI (-2.39, 2.05)], P = .88) 水平。血管扩张剂组的 SGRQ 总分明显降低（MD = -5.53 [95% CI (-9.81, -1.24)], P = .01）：结论：血管扩张剂对慢性阻塞性肺疾病的治疗效果尚存争议。在这项荟萃分析中，血管扩张剂对改善 COPD 患者的气血交换功能和生活质量有好处。不过，血管扩张剂改善肺功能的能力可能有限。
The effectiveness of vasodilators on chronic obstructive pulmonary disease: A systematic review and meta-analysis.
Background: Chronic obstructive pulmonary disease (COPD) is a complex progressive disease. Some vasodilators have been reported with therapeutic potential to protect vascular function therefore may delay the progression of COPD.
Methods: We searched PubMed, Embase, Cochrane Library, Web of Science, OVID and Clinicaltrials.gov database for eligible randomized controlled trials (RCTs) published before January 1, 2024. RCTs which treatment with vasodilators to COPD patients were included. Gas-blood exchange indicators were the primary outcomes, and ventilation function and quality of life indicators were the secondary outcomes. Mean differences with 95% confidence intervals were extracted. Subgroup analysis of vasodilator category and COPD complicated with or without pulmonary hypertension (PH) were performed. The risk of bias was assessed using Cochrane risk of bias tool, and the meta-analysis was conducted.
Results: Twenty studies with a total sample size of 986 were included. The results showed that the 2 types of drugs in vasodilators included PDE-5 inhibitors could improve DLCO (MD = 6.56 [95% CI (1.74, 11.39)], P = .008) and iNO could reduce PaCO2 (MD = -0.10 [95% CI (-0.17, -0.03)], P = .006). Vasodilators could reduce PaCO2 in COPD complicated with PH (COPD-PH) (MD = -0.10 [95% CI (-0.17, -0.03)], P = .006). There were no statistically significant differences in FEV1 (MD = 0.02 [95% CI (-0.11, 0.16)], P = .74), FEV1% predicted (MD = 0.07 [95% CI (-1.90, 2.05)], P = .94), FEV1/FVC (MD = 0.70 [95% CI (-4.02, 5.42)], P = .77) and VE/VCO2 (MD = -0.17 [95% CI (-2.39, 2.05)], P = .88) levels. The total SGRQ score was significantly lower in vasodilator groups (MD = -5.53 [95% CI (-9.81, -1.24)], P = .01).
Conclusions: The therapeutic effects of vasodilators for COPD are controversial. In this meta-analysis, vasodilators have benefits in improving gas-blood exchange function and quality of life in COPD patients. However, vasodilators may have a limited capacity to improve pulmonary function.
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