Wang Wuwan, Hu Xiankang, Liao Weitin, Rutahoile W H, Malenka David J, Zeng Xiaofang, Yang Yunjing, Feng Panpan, Wen Li, Huang Wei
1 Department of Cardiology, the First Affiliated Hospital, Chongqing Medical University, Chongqing, China.
2 Chongqing Medical University, Chongqing, China.
Pulm Circ. 2019 Jan-Mar;9(1):2045894018790450. doi: 10.1177/2045894018790450. Epub 2018 Jul 4.
No previous meta-analysis has evaluated the efficacy and safety of pulmonary vasodilators in Fontan physiology. Recent relative trials have obtained conflicting results regarding improvements in peak oxygen consumption; the relatively small number of patients in each study may be a limiting factor. We aimed to evaluate the efficacy and safety of pulmonary vasodilators in Fontan patients. Relevant studies were identified by searching the PubMed, Embase, and Cochrane Library databases. Pooled outcomes were determined to assess the efficacy and safety of pulmonary vasodilators in Fontan patients. Nine randomized controlled studies involving 381 patients with Fontan circulation were included. Pulmonary vasodilator therapy led to significant improvement (mean difference = -0.39, 95% CI: [-0.72, -0.05]) in the New York Heart Association (NYHA) functional class. The 6-minute walking distance (6MWD) was significantly increased by 134 m (95% CI: [86.07, 181.94]), and the peak VO was also significantly improved (mean difference = 1.42 ml·(kg·min), 95% CI: [0.21, 2.63]). Additionally, the mean pulmonary artery pressure (mPAP) was significantly reduced (mean difference = -2.25 mmHg, 95% CI: [-3.00, -1.50]). No significant change was found in mortality or in brain natriuretic peptide (BNP) or N-terminal pronatriuretic peptide (NT-proBNP). Four studies reported no side effects and good drug tolerance, and two studies reported mild adverse effects. The present meta-analysis indicated that pulmonary vasodilators (primarily the PDE-5 inhibitor and endothelin-1 receptor antagonist) significantly improved the hemodynamics of Fontan patients, reduced the NYHA functional class and increased the 6MWD. The peak oxygen consumption was also improved. No significant change was observed in mortality or in the BNP or NT-proBNP level. Overall, the pulmonary vasodilators were well tolerated. This finding needs to be confirmed in future studies.
此前尚无荟萃分析评估肺血管扩张剂在Fontan循环生理中的疗效和安全性。近期的相关试验在峰值耗氧量改善方面得出了相互矛盾的结果；每项研究中患者数量相对较少可能是一个限制因素。我们旨在评估肺血管扩张剂在Fontan患者中的疗效和安全性。通过检索PubMed、Embase和Cochrane图书馆数据库确定相关研究。确定汇总结果以评估肺血管扩张剂在Fontan患者中的疗效和安全性。纳入了9项涉及381例Fontan循环患者的随机对照研究。肺血管扩张剂治疗使纽约心脏协会（NYHA）功能分级有显著改善（平均差值=-0.39，95%置信区间：[-0.72，-0.05]）。6分钟步行距离（6MWD）显著增加了134米（95%置信区间：[86.07，181.94]），峰值VO也有显著改善（平均差值=1.42毫升·（千克·分钟），95%置信区间：[0.21，2.63]）。此外，平均肺动脉压（mPAP）显著降低（平均差值=-2.25毫米汞柱，95%置信区间：[-3.00，-1.50]）。在死亡率、脑钠肽（BNP）或N末端前脑钠肽原（NT-proBNP）方面未发现显著变化。4项研究报告无副作用且药物耐受性良好，2项研究报告有轻度不良反应。本荟萃分析表明，肺血管扩张剂（主要是磷酸二酯酶-5抑制剂和内皮素-1受体拮抗剂）显著改善了Fontan患者的血流动力学，降低了NYHA功能分级并增加了6MWD。峰值耗氧量也有所改善。在死亡率或BNP及NT-proBNP水平方面未观察到显著变化。总体而言，肺血管扩张剂耐受性良好。这一发现需要在未来研究中得到证实。
Zotero 插件
