肺动脉高压靶向治疗对肺部疾病相关肺动脉高压的血流动力学影响：系统评价和荟萃分析。

Haemodynamic effects of PAH-targeted therapies in pulmonary hypertension due to lung disease: A systematic review and meta-analysis.

机构信息

Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece.

Department of Cardiology, 424 General Military Training Hospital, Thessaloniki, Greece.

出版信息

Pulm Pharmacol Ther. 2021 Jun;68:102036. doi: 10.1016/j.pupt.2021.102036. Epub 2021 May 9.

DOI:10.1016/j.pupt.2021.102036

PMID:33979684

Abstract

BACKGROUND

Pulmonary hypertension (PH) is a negative predictor in patients with lung disease and/or hypoxia (group 3 PH). Current guidelines do not endorse the use of targeted therapies for pulmonary arterial hypertension (PAH) in patients with group 3 PH, due to lack of strong evidence. However, a variety of studies have examined the effect of PAH-targeted therapies in group 3 PH with mixed methods and conflicting results.

OBJECTIVE

To evaluate the effect of PAH-targeted therapies on haemodynamic parameters as assessed by right heart catheterization in patients with group 3 PH.

METHODS

Search strategy included PubMed and CENTRAL databases for randomized controlled trials from inception until Jan 30, 2020. We hand searched review articles, clinical trial registries and reference lists of retrieved articles. The primary outcome was the effect of PAH-targeted therapies on haemodynamic parameters [mean pulmonary arterial pressure (mPAP), pulmonary vascular resistance (PVR), cardiac index (CI) and right atrial pressure (RAP)] in patients with group 3 PH, while secondary outcomes were 6-min walking distance (6MWD), brain natriuretic peptide (BNP) and quality of life (QoL).

RESULTS

Five studies with a total of 140 patients were included. PAH-targeted therapies improved significantly mPAP [mean difference (MD) -4.02 mmHg, 95% CI -7.95;-0.09], and PVR [standardized mean difference (SMD) -0.29, 95% CI -0.50;-0.07], but not CI (SMD 0.23, 95% CI -0.23; 0.70) or RAP (MD 0.26 mmHg, 95% CI -18.75; 19.27). PAH-targeted therapies significantly increased the 6MWD by 38.5 m (95% CI 17.6; 59.4), while they did not manage to improve QoL (SMD -3.42, 95% CI -14.74; 7.91) or BNP values. There was no effect of oxygenation by the PAH-targeted therapies compared to placebo.

CONCLUSION

PAH-targeted therapies slightly improved mPAP and PVR in group 3 PH, without affecting CI. Larger RCTs targeted in specific subpopulations are needed to extract more robust conclusions.

PROTOCOL REGISTRATION

Open Science Framework 10.17605/OSF.IO/56FDW.

摘要

背景

肺动脉高压（PH）是肺部疾病和/或缺氧患者的负面预测因子（第 3 组 PH）。由于缺乏强有力的证据，目前的指南不支持在第 3 组 PH 患者中使用靶向肺动脉高压（PAH）的治疗方法。然而，各种研究使用混合方法和相互矛盾的结果检查了靶向 PH 治疗方法在第 3 组 PH 中的效果。

目的

评估靶向 PH 治疗方法对第 3 组 PH 患者右心导管检查评估的血流动力学参数的影响。

方法

检索策略包括从开始到 2020 年 1 月 30 日在 PubMed 和 CENTRAL 数据库中进行的随机对照试验。我们手动搜索了综述文章、临床试验登记处和检索到的文章的参考文献列表。主要结局是靶向 PH 治疗方法对第 3 组 PH 患者血流动力学参数[平均肺动脉压（mPAP）、肺血管阻力（PVR）、心指数（CI）和右心房压（RAP）]的影响，次要结局是 6 分钟步行距离（6MWD）、脑利钠肽（BNP）和生活质量（QoL）。

结果

共纳入 5 项研究，共 140 例患者。靶向 PH 治疗方法显著改善 mPAP[平均差值（MD）-4.02mmHg，95%置信区间（CI）-7.95；-0.09]和 PVR[标准化平均差值（SMD）-0.29，95%CI-0.50；-0.07]，但不影响 CI（SMD 0.23，95%CI-0.23；0.70）或 RAP（MD 0.26mmHg，95%CI-18.75；19.27）。靶向 PH 治疗方法使 6MWD 显著增加 38.5m（95%CI 17.6；59.4），但未能改善 QoL（SMD-3.42，95%CI-14.74；7.91）或 BNP 值。与安慰剂相比，PAH 靶向治疗方法对氧合没有影响。