Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China.
J Cardiovasc Pharmacol. 2012 Oct;60(4):342-6. doi: 10.1097/FJC.0b013e318262a793.
Clinical studies on combination therapy in patients with pulmonary arterial hypertension (PAH) revealed mixed results.
The aim of the present meta-analysis was to evaluate the effect of combination therapy on exercise capacity [measured with 6-minute walk distance (6MWD)] and clinical worsening in PAH patients.
We identified trials of importance from the Cochrane Library, EMBASE, and PUBMED databases, reviews, and reference lists of relevant articles. We calculated risk ratios for dichotomous data and weighted mean differences, with 95% confidence intervals (CIs), for net changes in 6MWD.
Seven trials with a total of 768 patients (386 patients in the combination treatment group and 382 patients in the monotherapy group) were included in the meta-analysis. Compared with the monotherapy group, combination therapy increased 6MWD by 21.59 meters (weighted mean difference 21.59 m, 95% CI of 13.25-29.93; P < 0.001) and reduced the risk of clinical worsening (risk ratio: 0.43, 95% CI: 0.26-0.72, P = 0.001). For both outcomes, no significant heterogeneity and publication bias were found.
Compared with monotherapy, combination therapy improves exercise capacity and reduces the risk of clinical worsening in PAH patients. In future studies, more large randomized controlled trials should be designed to adequately assess the efficacy and safety of combination therapy.
临床研究表明，肺动脉高压（PAH）患者的联合治疗结果喜忧参半。
本荟萃分析旨在评估联合治疗对 PAH 患者运动能力（以 6 分钟步行距离[6MWD]衡量）和临床恶化的影响。
我们从 Cochrane 图书馆、EMBASE 和 PUBMED 数据库、综述以及相关文章的参考文献中确定了有意义的试验。我们计算了二项数据的风险比和加权均数差值，并计算了 6MWD 净变化的 95%置信区间（CI）。
共有 7 项试验（共 768 例患者，联合治疗组 386 例，单药治疗组 382 例）纳入荟萃分析。与单药治疗组相比，联合治疗可使 6MWD 增加 21.59 米（加权均数差值 21.59 m，95%CI：13.25-29.93；P < 0.001），并降低临床恶化风险（风险比：0.43，95%CI：0.26-0.72，P = 0.001）。对于这两个结局，未发现明显的异质性和发表偏倚。
与单药治疗相比，联合治疗可提高 PAH 患者的运动能力，降低临床恶化风险。在未来的研究中，应设计更多的大型随机对照试验，以充分评估联合治疗的疗效和安全性。
