Nakashima Hirotaka, Watanabe Kazuhisa, Umegaki Hiroyuki, Suzuki Yusuke, Kuzuya Masafumi
1Centre for Community Liaison and Patient Consultations, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8560 Japan.
2Department of Geriatrics, Nagoya University Hospital, Nagoya, Japan.
Pneumonia (Nathan). 2018 Apr 5;10:3. doi: 10.1186/s41479-018-0046-5. eCollection 2018.
Pneumonia is a very common disease, especially among the elderly. Various drugs' preventive effects against pneumonia have been reported. The antiplatelet drug cilostazol is used to prevent pneumonia, but the robustness of its efficacy is unclear. This review estimates the effectiveness of cilostazol for preventing pneumonia in elderly individuals.
The following databases were searched from the earliest record to January 2016, without language restriction (the secondary search was conducted on February 2017): MEDLINE, Cochrane Library, CINAHL, and Ichushi-Web. Studies were included if they were published randomized controlled trials investigating the preventive effect of cilostazol on pneumonia in the elderly. The outcome was the incidence of pneumonia.
Two trials were identified that met the search criteria (1423 participants). Both trials compared cilostazol with no antiplatelet in patients with a history of cerebral infarction. A meta-analysis was not performed because of the small number of trials and the heterogeneity of the data. Both trials suggested that cilostazol reduced the incidence of pneumonia (risk ratio [RR] 0.40; 95% confidence interval [CI] 0.22-0.73 in one trial, RR 0.20; 95% CI 0.06-0.69 in the other) and the recurrence of cerebral infarction (0.43; 0.21-0.90, 0.53; 0.34-0.81, respectively). The quality of evidence provided by the trials was very low, mainly because of the high risk of bias.
It is difficult to draw conclusions on the basis of two trials. Moreover, in the two trials, cilostazol could have reduced the incidence of pneumonia via a reduction of the recurrence of cerebral infarction, which suggests that other antiplatelets could also have the same effects. Stronger evidence is required from large trials assessing the effectiveness of cilostazol for the prevention of pneumonia.
PROSPERO (CRD42016036724).
肺炎是一种非常常见的疾病，在老年人中尤为常见。已有多种药物对肺炎预防作用的报道。抗血小板药物西洛他唑用于预防肺炎，但其疗效的可靠性尚不清楚。本综述评估西洛他唑对预防老年人肺炎的有效性。
检索以下数据库从最早记录至2016年1月，无语言限制（2017年2月进行二次检索）：医学文献数据库（MEDLINE）、考克兰图书馆、护理学与健康领域数据库（CINAHL）和日本医学中央杂志网络版（Ichushi-Web）。纳入已发表的随机对照试验，这些试验研究西洛他唑对老年人肺炎的预防作用。结局指标为肺炎发病率。
确定两项符合检索标准的试验（1423名参与者）。两项试验均在有脑梗死病史的患者中将西洛他唑与未使用抗血小板药物进行比较。由于试验数量少且数据异质性，未进行荟萃分析。两项试验均提示西洛他唑降低了肺炎发病率（一项试验中风险比[RR]为0.40；95%置信区间[CI]为0.22 - 0.73，另一项试验中RR为0.20；95%CI为0.06 - 0.69）以及脑梗死复发率（分别为0.43；0.21 - 0.90，0.53；0.34 - 0.81）。试验提供的证据质量非常低，主要是因为偏倚风险高。
基于两项试验难以得出结论。此外，在这两项试验中，西洛他唑可能通过降低脑梗死复发率而降低了肺炎发病率，这表明其他抗血小板药物可能也有相同效果。需要来自大型试验的更强有力证据来评估西洛他唑预防肺炎的有效性。
国际前瞻性系统评价注册库（PROSPERO）（CRD42016036724）
