Arif Ragdah, Pandey Arjun, Zhao Ying, Arsenault-Mehta Kyle, Khoujah Danya, Mehta Sanjay
Respirology Division, Dept of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
Southwest Ontario Pulmonary Hypertension Clinic, Division of Respirology, Dept of Medicine, London Health Sciences Center, Schulich Faculty of Medicine & Dentistry, University of Western Ontario, London, ON, Canada.
ERJ Open Res. 2022 Feb 21;8(1). doi: 10.1183/23120541.00348-2021. eCollection 2022 Jan.
Chronic obstructive pulmonary disease-associated pulmonary hypertension (COPD-PH) is an increasingly recognised condition which contributes to worsening dyspnoea and poor survival in COPD. It is uncertain whether specific treatment of COPD-PH, including use of medications approved for pulmonary arterial hypertension (PAH), improves clinical outcomes. This systematic review and meta-analysis assesses potential benefits and risks of therapeutic options for COPD-PH. We searched Medline and Embase for relevant publications until September 2020. Articles were screened for studies on treatment of COPD-PH for at least 4 weeks in 10 or more patients. Screening, data extraction, and risk of bias assessment were performed independently in duplicate. When possible, relevant results were pooled using the random effects model. Supplemental long-term oxygen therapy (LTOT) mildly reduced mean pulmonary artery pressure (PAP), slowed progression of PH, and reduced mortality, but other clinical or functional benefits were not assessed. Phosphodiesterase type 5 inhibitors significantly improved systolic PAP (pooled treatment effect -5.9 mmHg; 95% CI -10.3, -1.6), but had inconsistent clinical benefits. Calcium channel blockers and endothelin receptor antagonists had limited haemodynamic, clinical, or survival benefits. Statins had limited clinical benefits despite significantly lowering systolic PAP (pooled treatment effect -4.6 mmHg; 95% CI -6.3, -2.9). This review supports guideline recommendations for LTOT in hypoxaemic COPD-PH patients as well as recommendations against treatment with PAH-targeted medications. Effective treatment of COPD-PH depends upon research into the pathobiology and future high-quality studies comprehensively assessing clinically relevant outcomes are needed.
慢性阻塞性肺疾病相关肺动脉高压（COPD-PH）是一种日益受到认可的疾病，它会导致COPD患者呼吸困难加重和生存率降低。COPD-PH的特异性治疗，包括使用已获批用于肺动脉高压（PAH）的药物，是否能改善临床结局尚不确定。本系统评价和荟萃分析评估了COPD-PH治疗方案的潜在益处和风险。我们检索了Medline和Embase数据库，以获取截至2020年9月的相关出版物。筛选纳入至少10例患者、治疗COPD-PH至少4周的研究文章。筛选、数据提取和偏倚风险评估由两人独立重复进行。尽可能使用随机效应模型汇总相关结果。补充长期氧疗（LTOT）可轻度降低平均肺动脉压（PAP），减缓PH进展并降低死亡率，但未评估其他临床或功能益处。5型磷酸二酯酶抑制剂可显著改善收缩期PAP（汇总治疗效应-5.9 mmHg；95% CI -10.3，-1.6），但临床益处不一致。钙通道阻滞剂和内皮素受体拮抗剂在血流动力学、临床或生存方面的益处有限。他汀类药物尽管可显著降低收缩期PAP（汇总治疗效应-4.6 mmHg；95% CI -6.3，-2.9），但其临床益处有限。本综述支持对低氧性COPD-PH患者进行LTOT的指南建议，以及反对使用PAH靶向药物治疗的建议。COPD-PH的有效治疗取决于对病理生物学的研究，未来需要高质量研究全面评估临床相关结局。
