Department of Pediatrics, Renmin Hospital of Wuhan University, Wuhan, China.
Circ J. 2010 Jul;74(7):1458-64. doi: 10.1253/circj.cj-09-0971. Epub 2010 Jun 1.
The aim of the present meta-analysis was to evaluate the efficacy and safety of treating pulmonary arterial hypertension (PAH) with inhaled iloprost, oral bosentan and sildenafil.
The randomized controlled trials on the 3 drugs and placebo were retrieved from the databases MEDLINE, EMBASE, BIOSIS Previews and CNKI up to August 2009. In total 11 studies and 1,391 patients were selected. Compared with placebo, iloprost, bosentan and sildenafil reduced clinical worsening significantly (odds ratio [OR] =0.33, 95% confidence interval [CI] =0.22-0.49, P<0.00001), improved New York Heart Association/World Health Organization functional class (OR =2.81, 95%CI =1.95-4.03, P<0.00001), increased the 6-min walk test by 33.19 m, reduced systolic pulmonary arterial pressure, mean pulmonary arterial pressure and pulmonary vascular resistance, increased the cardiac index by 0.40 L x min(-1) x m(-2) and increased the cardiac output by 0.53 L/min. The incidence of serious adverse events was similar in the medication groups and the placebo group (OR =1.09, 95%CI =0.69-1.71, P=0.72). In terms of the clinical worsening and functional class amelioration, insignificant differences were found among iloprost, bosentan and sildenafil, but iloprost had the highest incidence of serious adverse events among the 3 drugs.
Inhaled iloprost and oral bosentan and sildenafil are effective and safe in treating PAH.
本荟萃分析旨在评估吸入伊洛前列素、口服波生坦和西地那非治疗肺动脉高压（PAH）的疗效和安全性。
从 MEDLINE、EMBASE、BIOSIS Previews 和中国知网（CNKI）数据库中检索到这 3 种药物和安慰剂的随机对照试验，检索时间截至 2009 年 8 月。共纳入 11 项研究，1391 例患者。与安慰剂相比，伊洛前列素、波生坦和西地那非可显著降低临床恶化风险（比值比 [OR] =0.33，95%置信区间 [CI] =0.22-0.49，P<0.00001），改善纽约心脏协会/世界卫生组织功能分级（OR =2.81，95%CI =1.95-4.03，P<0.00001），6 分钟步行试验距离增加 33.19 m，降低收缩压肺动脉压、平均肺动脉压和肺血管阻力，心指数增加 0.40 L x min(-1) x m(-2)，心输出量增加 0.53 L/min。药物组与安慰剂组严重不良事件发生率相似（OR =1.09，95%CI =0.69-1.71，P=0.72）。在临床恶化和功能分级改善方面，伊洛前列素、波生坦和西地那非之间无显著差异，但伊洛前列素的严重不良事件发生率最高。
吸入伊洛前列素和口服波生坦及西地那非治疗 PAH 有效且安全。
