内皮素受体拮抗剂、5型磷酸二酯酶抑制剂和前列腺素在小儿肺动脉高压中的疗效与安全性：一项网状荟萃分析
Efficacy and safety of endothelin receptor antagonists, phosphodiesterase type 5 Inhibitors, and prostaglandins in pediatric pulmonary arterial hypertension: A network meta-analysis.
作者信息
Cao Fen, Wu Kun, Zhu Yong-Zhi, Jiang Jun-Jun, Zhang Gui, Liu Jun, Xiao Ping, Tian Yang, Zhang Wei, Zhang Sheng, Hou Feng, Bao Zhong-Wu
机构信息
Department of Cardiology, Huaihua First People's Hospital, Huaihua, China.
Department of Neurology, Huaihua First People's Hospital, Huaihua, China.
出版信息
Front Cardiovasc Med. 2023 Jan 11;9:1055897. doi: 10.3389/fcvm.2022.1055897. eCollection 2022.
BACKGROUND
Pulmonary arterial hypertension (PAH) is a fatal disease characterized by pulmonary vascular remodeling and increased pulmonary artery pressure, leading to impaired lung oxygenation, right heart failure, and even death. Although great advances have been made in PAH-targeted medications for pediatric patients, the efficacy and safety of these treatments are controversial.
METHODS
We retrieved relevant articles from electronic databases including PubMed, EMBASE, Web of Science, and Cochrane Library until 12 April 2022. To compare the effectiveness and safety of endothelin receptor antagonists (ERAs), phosphodiesterase type 5 Inhibitors (PDE-5i), and prostaglandins (ProA) in the treatment of pediatric PAH, we investigated six hemodynamic parameters, four respiratory parameters, intensive care unit (ICU) stay duration, length of hospital stay, and two safety outcomes.
RESULTS
A total of 27 randomized controlled trials (RCTs) were included in the meta-analysis with 1,574 pediatric participants. The duration of mechanical ventilation was shorter for patients using bosentan, sildenafil, and ProsA, compared with that for patients using the placebo. Bosentan helped to shorten more time for mechanical ventilation than ProsA did, while ProsA was more effective than sildenafil in this respect. As for the length of stay in the ICU, patients administered by ProsA or sildenafil needed shorter ICU stay, compared to those using the placebo, while ProsA was more effective for shortening ICU stay time. In light of safety outcomes, there was a statistically significant difference between the sildenafil and the placebo group. Sildenafil surpassed ProsA in reducing the incidence of pulmonary hypertension (PH) crisis.
CONCLUSIONS
ERAs were more effective than ProsA in shortening the duration of mechanical ventilation, while ProsA were better for shortening the duration of mechanical ventilation and ICU stay than PDE-5i. PDE-5i were found to generate more benefits in decreasing the occurrence of PH crisis, though further investigation is warranted.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=351505.
背景
肺动脉高压（PAH）是一种致命疾病，其特征为肺血管重塑和肺动脉压力升高，导致肺氧合受损、右心衰竭甚至死亡。尽管针对儿科患者的PAH靶向药物已取得了巨大进展，但这些治疗方法的疗效和安全性仍存在争议。
方法
我们从包括PubMed、EMBASE、Web of Science和Cochrane图书馆在内的电子数据库中检索相关文章，检索截止至2022年4月12日。为比较内皮素受体拮抗剂（ERAs）、5型磷酸二酯酶抑制剂（PDE-5i）和前列腺素（ProA）治疗儿科PAH的有效性和安全性，我们调查了六个血流动力学参数、四个呼吸参数、重症监护病房（ICU）住院时间、住院时长以及两个安全性指标。
结果
荟萃分析共纳入27项随机对照试验（RCT），涉及1574名儿科参与者。与使用安慰剂的患者相比，使用波生坦、西地那非和ProA的患者机械通气时间更短。波生坦比ProA更有助于缩短机械通气时间，而在这方面ProA比西地那非更有效。至于ICU住院时长，使用ProA或西地那非的患者比使用安慰剂的患者ICU住院时间更短，而ProA在缩短ICU住院时间方面更有效。在安全性指标方面，西地那非组与安慰剂组之间存在统计学显著差异。西地那非在降低肺动脉高压（PH）危象发生率方面超过了ProA。
结论
ERAs在缩短机械通气时间方面比ProA更有效，而ProA在缩短机械通气时间和ICU住院时间方面比PDE-5i更好。尽管有必要进行进一步研究，但发现PDE-5i在降低PH危象发生率方面有更多益处。
系统评价注册
https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=351505
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