小剂量阿奇霉素联用辛伐他汀治疗慢性阻塞性肺病合并肺动脉高压的系统评价

Meta analysis of low-doses of Azithromycin combined with Simvastatin in the treatment of Chronic Obstructive Pulmonary Disease Combined with Pulmonary Hypertension

关键词:  阿奇霉素  辛伐他汀  慢性阻塞性肺疾病  肺动脉高压  临床疗效  meta分析

Key words:  azithromycin  simvastatin  chronic obstructive pulmonary disease  pulmonary hypertension  clinical efficacy  meta analysis

摘要:

目的 系统评价小剂量阿奇霉素联用辛伐他汀治疗慢性阻塞性肺病（chronic obstructive pulmonary disease，COPD）合并肺动脉高压（pulmonary hypertension，PH）的临床疗效和安全性。方法 计算机检索PubMed、Medline、CNKI、VIP、万方等数据库，收集小剂量阿奇霉素联用辛伐他汀治疗COPD合并PH的临床随机对照研究，检索年限为2000年1月—2016年10月。由2名研究者独立提取数据、评价质量，并交叉核对。采用RevMan 5.2软件进行meta分析。结果 共纳入11项研究，943例患者。Meta分析结果显示，小剂量阿奇霉素联用辛伐他汀能显著提高COPD合并HP患者一秒用力呼吸容积[MD=0.31，95% CI（0.24，0.38），P>0.001]、血氧饱和度[MD=3.89，95% CI（3.29，4.50），P>0.001]、6s步行距离[MD=77.01，95% CI（72.88，81.14），P>0.001]，显著降低肺动脉压[MD=-1.82，95% CI（-2.27，-1.36），P>0.001]和C反应蛋白[MD=-8.91，95% CI（-10.42，-7.39），P>0.001]。2组均未发生严重不良反应。倒漏斗图提示发表偏倚性较小。结论 小剂量阿奇霉素联用辛伐他汀能显著改善COPD合并PH患者肺功能、血氧饱和度，提高活动耐受力，同时显著降低肺动脉压和C反应蛋白，且安全可靠。

Abstract:

OBJECTIVE To systematically review low-dose of azithromycin combined with simvastatin in treatment of chronic obstructive pulmonary disease(COPD) combined with pulmonary hypertension(PH). METHODS Databases including PubMed, Medline, CNKI, VIP and WanFang Data were searched to collect randomized controlled trials (RCTs) about low-dose of azithromycin combined with simvastatin in the treatment of COPD combined with PH from Jan. 2000 to Oct. 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was conducted by RevMan 5.2 software. RESULTS Total of 11 RCTs, 943 patients were included. Meta-analysis showed that, low-dose of azithromycin combined with simvastatin could significantly improve the COPD combined with PH patients in FEV1[MD=0.25, 95%CI(0.18, 0.32), P>0.001], SaO₂%[MD=3.89, 95%CI(3.29, 4.50), P>0.001], 6MWD[MD=76.25, 95%CI(71.95, 80.55, P>0.01], meanwhile significantly reduce in pulmonary hypertension[MD=-1.54, 95%CI(-1.83, -1.24), P>0.001] and CRP[MD=-8.86, 95%CI(-10.49, -7.23), P>0.001]. There were no serious adverse reactions in both groups. The inverted funnel plot suggested that the inclusion of the research publication bias was small. CONCLUSION Low-dose of azithromycin combined with simvastatin can improve lung function, dyspnea, the activity tolerancen and reduce pulmonary hypertension in patients with COPD combined with PH.