He Chao-Jie, Chen Shao-Jie, Wang Jie, Zhu Chun-Yan, Yin Yue-Hui
Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, The Chongqing Cardiac Arrhythmias Service Center, Chongqing, 400010, China.
Department of Medicine/Cardiology, Shanghai First People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China.
Pulm Pharmacol Ther. 2015 Jun;32:24-8. doi: 10.1016/j.pupt.2015.03.002. Epub 2015 Apr 2.
Phosphodiesterase type-5 inhibitors (PDE-5 inhibitors) have been suggested as a first-line drug for treating pulmonary arterial hypertension (PAH). The aim of present meta-analysis was to fully evaluate the efficacy and safety of treating PAH with PDE-5 inhibitors, focusing on the improvement of 6-min walk distance (6MWD).
Studies were identified from The Cochrane Library, EMBASE, and PUBMED databases. We calculated odds ratios (OR) for dichotomous data and weighted mean differences with 95% confidence intervals (CI) for continuous data.
Six studies with a total of 1056 patients (729 patients in PDE-5 inhibitors treatment group and 327 patients in placebo group) were included. All-cause mortality rate in the control group and PDE-5 inhibitors group was 2.6% and 0.7%, respectively. In an average of 12.3-week follow-up, PDE-5 inhibitors treatment was associated with a 71% reduction in mortality (OR 0.29; 95 %CI 0.07-1.15; P = 0.08), and increased 6MWD by 40.17 m, improved NYHA functional class and hemodynamic parameters. As for monotherapy and combination therapy patients, 6MWD has improved by 48.94 m and 21.75 m, respectively.
The results of present meta-analysis suggest that treatment with PDE-5 inhibitors improves the 6MWD, clinical symptoms, hemodynamic parameters, and a tendency of survival benefits. In patients treated with PDE-5 inhibitor monotherapy, the 6MWD significantly increased when compared to combination therapies.
5型磷酸二酯酶抑制剂（PDE-5抑制剂）已被推荐作为治疗肺动脉高压（PAH）的一线药物。本荟萃分析的目的是全面评估PDE-5抑制剂治疗PAH的疗效和安全性，重点关注6分钟步行距离（6MWD）的改善情况。
从Cochrane图书馆、EMBASE和PUBMED数据库中检索研究。我们计算了二分数据的比值比（OR）以及连续数据的加权平均差和95%置信区间（CI）。
纳入了6项研究，共1056例患者（PDE-5抑制剂治疗组729例，安慰剂组327例）。对照组和PDE-5抑制剂组的全因死亡率分别为2.6%和0.7%。在平均12.3周的随访中，PDE-5抑制剂治疗使死亡率降低了71%（OR 0.29；95%CI 0.07-1.15；P = 0.08），6MWD增加了40.17米，改善了纽约心脏协会（NYHA）功能分级和血流动力学参数。对于单药治疗和联合治疗的患者，6MWD分别改善了48.94米和21.75米。
本荟萃分析结果表明，PDE-5抑制剂治疗可改善6MWD、临床症状、血流动力学参数，并具有生存获益趋势。与联合治疗相比，接受PDE-5抑制剂单药治疗的患者6MWD显著增加。
