中国循证心血管医学杂志
中國循證心血管醫學雜誌
중국순증심혈관의학잡지
CHINESE JOURNAL OF EVIDENCE-BASES CARDIOVASCULAR MEDICINE
2014年
6期
663-669
,共7页
梁富翔%宋兵%祁泉%李元敏%刘瑞生
樑富翔%宋兵%祁泉%李元敏%劉瑞生
량부상%송병%기천%리원민%류서생
内皮素受体拮抗剂%肺动脉高压%安贝生坦%波生坦%西他生坦%马西替坦%网状Meta分析
內皮素受體拮抗劑%肺動脈高壓%安貝生坦%波生坦%西他生坦%馬西替坦%網狀Meta分析
내피소수체길항제%폐동맥고압%안패생탄%파생탄%서타생탄%마서체탄%망상Meta분석
Endothelin receptor antagonists%Pulmonary arterial hypertension%Ambrisentan%Bosentan%Sitaxsentan%Macitentan%Network Meta-analysis
目的：采用网状Meta分析的方法比较安贝生坦、波生坦、西他生坦和马西替坦四种内皮素受体拮抗剂治疗肺动脉高压的疗效和耐受性。方法计算机检索PubMed、EMBASE、Cochrane Library和中国生物医学文献数据库、中国知网、万方数据库，检索时间截至2014年1月31日，纳入比较四种内皮素受体拮抗剂治疗肺动脉高压的随机对照试验，主要结局指标为疗效和耐受性，次要结局指标为病死率和临床恶化率。研究筛选、数据提取及方法学质量评价均由两人独立完成。分别使用 RevMan 5.2和GEMTC软件进行直接比较和网状Meta分析。结果纳入12篇文献，包含13个随机对照试验，总计2191例患者。直接Meta分析结果显示，4种内皮素受体拮抗剂疗效均优于安慰剂，在耐受性方面，只有安贝生坦的效果优于安慰剂，其余药物与安慰剂的比较差异无统计学意义。网状Meta分析结果显示：在疗效方面，安贝生坦和波生坦的疗效优于安慰剂，西他生坦及马西替坦与安慰剂比较以及各种药物的互相比较差异均无统计学意义。等级概率图显示：安贝生坦效果最佳，其次为波生坦、西他生坦，马西替坦疗效最差。在耐受性方面，安贝生坦与西他生坦优于安慰剂，其余药物与安慰剂的比较以及各类药物之间的比较差异均无统计学意义。等级概率图显示：耐受性最好的药物为安贝生坦，其余依次为西他生坦、马西替坦，最差为波生坦。结论在治疗肺动脉高压的4种内皮素受体拮抗剂中，安贝生坦在疗效和耐受性方面均优于其他3种药物。在未来的研究中，应该更多关注安贝生坦及其他药物在病死率和临床恶化率方面的效果，此外，应注重探讨不同药物剂量、不同类型肺动脉高压患者的具体疗效。
目的：採用網狀Meta分析的方法比較安貝生坦、波生坦、西他生坦和馬西替坦四種內皮素受體拮抗劑治療肺動脈高壓的療效和耐受性。方法計算機檢索PubMed、EMBASE、Cochrane Library和中國生物醫學文獻數據庫、中國知網、萬方數據庫，檢索時間截至2014年1月31日，納入比較四種內皮素受體拮抗劑治療肺動脈高壓的隨機對照試驗，主要結跼指標為療效和耐受性，次要結跼指標為病死率和臨床噁化率。研究篩選、數據提取及方法學質量評價均由兩人獨立完成。分彆使用 RevMan 5.2和GEMTC軟件進行直接比較和網狀Meta分析。結果納入12篇文獻，包含13箇隨機對照試驗，總計2191例患者。直接Meta分析結果顯示，4種內皮素受體拮抗劑療效均優于安慰劑，在耐受性方麵，隻有安貝生坦的效果優于安慰劑，其餘藥物與安慰劑的比較差異無統計學意義。網狀Meta分析結果顯示：在療效方麵，安貝生坦和波生坦的療效優于安慰劑，西他生坦及馬西替坦與安慰劑比較以及各種藥物的互相比較差異均無統計學意義。等級概率圖顯示：安貝生坦效果最佳，其次為波生坦、西他生坦，馬西替坦療效最差。在耐受性方麵，安貝生坦與西他生坦優于安慰劑，其餘藥物與安慰劑的比較以及各類藥物之間的比較差異均無統計學意義。等級概率圖顯示：耐受性最好的藥物為安貝生坦，其餘依次為西他生坦、馬西替坦，最差為波生坦。結論在治療肺動脈高壓的4種內皮素受體拮抗劑中，安貝生坦在療效和耐受性方麵均優于其他3種藥物。在未來的研究中，應該更多關註安貝生坦及其他藥物在病死率和臨床噁化率方麵的效果，此外，應註重探討不同藥物劑量、不同類型肺動脈高壓患者的具體療效。
목적：채용망상Meta분석적방법비교안패생탄、파생탄、서타생탄화마서체탄사충내피소수체길항제치료폐동맥고압적료효화내수성。방법계산궤검색PubMed、EMBASE、Cochrane Library화중국생물의학문헌수거고、중국지망、만방수거고，검색시간절지2014년1월31일，납입비교사충내피소수체길항제치료폐동맥고압적수궤대조시험，주요결국지표위료효화내수성，차요결국지표위병사솔화림상악화솔。연구사선、수거제취급방법학질량평개균유량인독립완성。분별사용 RevMan 5.2화GEMTC연건진행직접비교화망상Meta분석。결과납입12편문헌，포함13개수궤대조시험，총계2191례환자。직접Meta분석결과현시，4충내피소수체길항제료효균우우안위제，재내수성방면，지유안패생탄적효과우우안위제，기여약물여안위제적비교차이무통계학의의。망상Meta분석결과현시：재료효방면，안패생탄화파생탄적료효우우안위제，서타생탄급마서체탄여안위제비교이급각충약물적호상비교차이균무통계학의의。등급개솔도현시：안패생탄효과최가，기차위파생탄、서타생탄，마서체탄료효최차。재내수성방면，안패생탄여서타생탄우우안위제，기여약물여안위제적비교이급각류약물지간적비교차이균무통계학의의。등급개솔도현시：내수성최호적약물위안패생탄，기여의차위서타생탄、마서체탄，최차위파생탄。결론재치료폐동맥고압적4충내피소수체길항제중，안패생탄재료효화내수성방면균우우기타3충약물。재미래적연구중，응해경다관주안패생탄급기타약물재병사솔화림상악화솔방면적효과，차외，응주중탐토불동약물제량、불동류형폐동맥고압환자적구체료효。
Objective To compare the curative effect and tolerability of 4 kinds of endothelin receptor antagonists (ambrisentan, bosentan, sitaxsentan and macitentan) in treatment of pulmonary arterial hypertension (PAH) by applying network Meta-analysis.Methods The databases of PubMed, EMBase, Cochrane Library, CBM, CNKI and WanFang Database were retrieved with computer until Jan. 31, 2014 for collecting randomized controlled trials (RCT) about treatment of PAH with 4 kinds of endothelin receptor antagonists. The primary outcome indexes were curative effect and tolerability and secondary ones were mortality and clinical worsening rate. All data was screened, extracted and reviewed by 2 researchers independently, compared directly and given network Meta-analyzed by using RevMan5.2 software and GEMTC software.Results There were 12 documents enclosed including 13 RCT involving 2191 patients. The direct Meta-analysis showed that the curative effect of 4 kinds of endothelin receptor antagonists was all better than that of placebo, and tolerability of only ambrisentan was better than that of placebo. The network Meta-analysis showed that the curative effect of ambrisentan and bosentan was better than that of placebo. The rank probability plot showed that the curative effect of ambrisentan was the best and then bosentan, sitaxsentan and macitentan in a descending order. The tolerability of ambrisentan and sitaxsentan were better than that of placebo. The rank probability plot showed that the tolerability of ambrisentan was the highest and then sitaxsentan, macitentan and bosentan in a descending order.Conclusion Among 4 kinds of endothelin receptor antagonists, ambrisentan is superior to other 3 in curative and tolerability. In the future studies, the effects of ambrisentan and other drugs on mortality and clinical worsening rate should be paid more attention to. In addition the curative effects of different drug dosage and specific effect on different types of PAH patients should be investigated.
