茚达特罗/格隆溴铵对慢性阻塞性肺疾病患者的肺功能和心血管事件的影响：一项荟萃分析。
Indacaterol/glycopyrronium affects lung function and cardiovascular events in patients with chronic obstructive pulmonary diseases: A meta-analysis.
机构信息
Division of Respiratory Medicine, The Affiliated Hospital of Hangzhou Normal University, Hangzhou 310015, China; School of Medicine, Hangzhou Normal University, Hangzhou, China.
School of Medicine, Hangzhou Normal University, Hangzhou, China.
出版信息
Heart Lung. 2021 Jul-Aug;50(4):532-541. doi: 10.1016/j.hrtlng.2021.02.018. Epub 2021 Apr 14.
BACKGROUND
Bronchodilators are the cornerstone for treating patients with chronic obstructive pulmonary diseases (COPD), although some studies have shown that dual bronchodilators may exacerbate incidence of adverse cardiovascular events. Here, we evaluated the cardiopulmonary safety of indacaterol/glycopyrronium (IND/GLY) using a meta-analysis.
METHODS
We searched PubMed, OVID, Cochrane Library and Web of Science databases, using "indacaterol/glycopyrronium", "indacaterol/glycopyrrolate", "IND/GLY", "QVA149", "chronic obstructive pulmonary diseases", "COPD", "chronic obstructive airway disease", "chronic obstructive lung disease" as key words. Acute exacerbation of COPD and FEV as indicators of pulmonary function and occurrence of hypertension, atrial fibrillation, myocardial infarction and heart failure as indicators of cardiovascular safety.
RESULTS
A total of 23 articles, comprising 21,238 participants, were included in the analysis. FEV values were significantly different compared to IND/GLY and single bronchodilator therapy (LABA or LAMA), with the MD 0.11 L (95%CI: 0.10-0.13, P<0.01). Hypertension was more frequent in the IND/GLY, than the single bronchodilator therapy group, although this difference was insignificant (IND/GLY vs LABA, RR=1.88, P = 0.09; IND/GLY vs LAMA, RR=1.42, P = 0.08; IND/GLY vs LABA+ICS, RR=1.85, P = 0.23). In addition, IND/GLY did not significantly increase the risk of myocardial infarction (IND/GLY vs LAMA or double therapy, total RR: 1.49, 95%CI: 0.72-3.08, P = 0.28), atrial fibrillation (IND/GLY vs LAMA, RR: 1.62, 95%CI: 0.64-4.10, P = 0.31) and heart failure (IND/GLY vs LAMA, RR: 0.40, 95%CI: 0.07-2.33, P = 0.31) in COPD patients.
CONCLUSIONS
IND/GLY significantly reduced incidence of acute COPD exacerbations, and slowed down the decline of FEV. Adequate safety measures are needed to control incidence of adverse cardiovascular events.
背景
支气管扩张剂是治疗慢性阻塞性肺疾病（COPD）患者的基石，尽管一些研究表明，双重支气管扩张剂可能会增加不良心血管事件的发生率。在这里，我们通过荟萃分析评估了吲哚洛尔/格隆溴铵（IND/GLY）的心肺安全性。
方法
我们使用“indacaterol/glycopyrronium”、“indacaterol/glycopyrrolate”、“IND/GLY”、“QVA149”、“慢性阻塞性肺疾病”、“COPD”、“慢性阻塞性气道疾病”、“慢性阻塞性肺病”作为关键词，在 PubMed、OVID、Cochrane Library 和 Web of Science 数据库中进行检索。急性加重 COPD 和 FEV 作为肺功能指标，高血压、心房颤动、心肌梗死和心力衰竭作为心血管安全性指标。
结果
共纳入 23 篇文章，共计 21238 名参与者。FEV 值与 IND/GLY 和单一支气管扩张剂治疗（LABA 或 LAMA）相比有显著差异，MD 为 0.11L（95%CI：0.10-0.13，P<0.01）。与单一支气管扩张剂治疗组相比，IND/GLY 组高血压的发生率更高，但差异无统计学意义（IND/GLY 与 LABA，RR=1.88，P=0.09；IND/GLY 与 LAMA，RR=1.42，P=0.08；IND/GLY 与 LABA+ICS，RR=1.85，P=0.23）。此外，IND/GLY 并未显著增加心肌梗死的风险（IND/GLY 与 LAMA 或双重治疗相比，总 RR：1.49，95%CI：0.72-3.08，P=0.28）、心房颤动（IND/GLY 与 LAMA，RR：1.62，95%CI：0.64-4.10，P=0.31）和心力衰竭（IND/GLY 与 LAMA，RR：0.40，95%CI：0.07-2.33，P=0.31）的发生率。
结论
IND/GLY 可显著降低 COPD 急性加重的发生率，并减缓 FEV 的下降速度。需要采取适当的安全措施来控制不良心血管事件的发生率。
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