Chen Xuesong, Tang Shaowen, Liu Kouying, Li Qinling, Kong Hui, Zeng Xiaoning, Xie Weiping, Wang Hong
1 Department of Respiratory, First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, China ; 2 Department of Epidemiology & Biostatistics, School of Public Health, Nanjing Medical University, Nanjing 210029, China ; 3 Department of Respiratory, Xuzhou No. 1 Hospital, Xuzhou 221002, China.
J Thorac Dis. 2015 Mar;7(3):309-19. doi: 10.3978/j.issn.2072-1439.2015.02.08.
Pulmonary hypertension (PH) is a common complication of chronic obstructive pulmonary disease (COPD) without effective drugs to treat. We conducted a systematic review and meta-analysis in order to evaluate whether PH specific therapies were effective for stable COPD patients. Data were extracted from PubMed, Cochrane Central Register of Controlled Trials and China Knowledge Resource Integrated Database. Randomized controlled trials (RCTs) with PH specific therapy treated more than 4 weeks in COPD were selected. The main outcome was exercise capacity; meanwhile pulmonary arterial pressure (PAP), hypoxemia and health related life quality were also measured. We included nine trials involving 365 subjects, among which two were treated with bosentan and seven with sildenafil. The study time varied from 4 weeks to 18 months and mostly it was 12 weeks. In a pooled analysis of nine trials, exercise capacity of COPD patients was improved by PH-specific therapy [mean difference (MD) 66.39 m, 95% confidence intervals (CI): 59.44-73.34]. COPD with severe PH (mean PAP >35 mmHg by right heart catheterization or systolic PAP >50 mmHg by echocardiography) improved the exercise capacity (MD 67.24 m, 95% CI: 60.26-74.23), but COPD without PH at rest did not (MD -9.24 m, 95% CI: -75.08 to 56.31). Meanwhile PAP was decreased (MD -9.02 mmHg, 95% CI: -10.71 to -7.34 mmHg). Although hypoxemia and life quality were not improved, the dyspnea was alleviated or at least not aggravated (Borg dyspnea index, MD -0.86, 95% CI: -1.86 to 0.14). In conclusion, PH specific drugs (especially sildenafil) could improve exercise capacity and decrease PAP in COPD patients with severe PH.
肺动脉高压（PH）是慢性阻塞性肺疾病（COPD）的常见并发症，目前尚无有效的治疗药物。我们进行了一项系统评价和荟萃分析，以评估PH特异性疗法对稳定期COPD患者是否有效。数据来自PubMed、Cochrane对照试验中央注册库和中国知网数据库。选择在COPD患者中进行的、采用PH特异性疗法治疗超过4周的随机对照试验（RCT）。主要结局指标为运动能力；同时还测量了肺动脉压（PAP）、低氧血症和健康相关生活质量。我们纳入了9项试验，共365名受试者，其中2项使用波生坦治疗，7项使用西地那非治疗。研究时间从4周至18个月不等，大部分为12周。在对9项试验的汇总分析中，PH特异性疗法改善了COPD患者的运动能力[平均差（MD）66.39 m，95%置信区间（CI）：59.44 - 73.34]。重度PH的COPD患者（经右心导管检查平均PAP>35 mmHg或经超声心动图检查收缩期PAP>50 mmHg）运动能力得到改善（MD 67.24 m，95% CI：60.26 - 74.23），但静息时无PH的COPD患者运动能力未改善（MD -9.24 m，95% CI：-75.08至56.31）。同时PAP降低（MD -9.02 mmHg，95% CI：-10.71至-7.34 mmHg）。虽然低氧血症和生活质量未得到改善，但呼吸困难得到缓解或至少未加重（Borg呼吸困难指数，MD -0.86，95% CI：-1.86至0.14）。总之，PH特异性药物（尤其是西地那非）可改善重度PH的COPD患者的运动能力并降低PAP。
