Respiratory Department, Hospital Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, Spain.
Respiratory Department, Hospital Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, Spain; CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain.
Med Clin (Barc). 2024 Sep 27;163(6):269-274. doi: 10.1016/j.medcli.2024.03.014. Epub 2024 Jun 21.
Chronic thromboembolic pulmonary hypertension (CTEPH) is a complication of pulmonary embolism and a major cause of chronic pulmonary hypertension leading to right heart failure and death. While pulmonary endarterectomy is the treatment of choice, some patients might benefit from medical therapy or balloon pulmonary angioplasty. Sex differences in outcomes of these therapies are not well characterized.
We conducted a systematic review and meta-analysis to investigate sex differences in outcomes of various therapies for CTEPH. We searched MEDLINE, PubMed, Embase, CINAHL and the Cochrane Library databases between January 1, 2010 and April 30, 2021, published in English. We pooled incidence estimates using random-effects meta-analyses. We evaluated heterogeneity using the I statistic. We assessed publication bias using Begg's and Egger's tests. This study is registered in PROSPERO, CRD42021268504.
A total of 19 studies met the eligibility criteria, but only 3 trials provided separate outcomes for women and men. Two studies evaluated the efficacy of BPA, and one study evaluated the efficacy of riociguat (129 patients). Overall, 57.3% of patients were women and 62.6% were in functional class III. Mean time of follow-up was 55.5 (SD 26.1) weeks. Women showed a significantly better response in cardiac index (mean difference [MD], 0.10L/min/m; 95% confidence interval [CI], 0.04-0.16; I=0%; P=0.001). Alternatively, the reduction of pulmonary vascular resistances was significantly higher for men than for women (MD, 161.17dynscm; 95% CI, 67.99-254.35; I=0%; P=0.0007).
Women and men might show different hemodynamic responses to riociguat or BPA for CTEPH.
慢性血栓栓塞性肺动脉高压（CTEPH）是肺栓塞的一种并发症，也是导致右心衰竭和死亡的慢性肺动脉高压的主要原因。虽然肺动脉内膜切除术是首选治疗方法，但一些患者可能受益于药物治疗或球囊肺动脉成形术。这些治疗方法的性别结局差异尚未得到很好的描述。
我们进行了系统评价和荟萃分析，以研究 CTEPH 各种治疗方法的性别结局差异。我们检索了 2010 年 1 月 1 日至 2021 年 4 月 30 日期间 MEDLINE、PubMed、Embase、CINAHL 和 Cochrane 图书馆数据库中的英文文献。我们使用随机效应荟萃分析汇总发病率估计值。我们使用 I 统计量评估异质性。我们使用贝叶斯和埃格检验评估发表偏倚。本研究已在 PROSPERO 注册，CRD42021268504。
共有 19 项研究符合入选标准，但只有 3 项试验为女性和男性分别提供了结局数据。两项研究评估了 BPA 的疗效，一项研究评估了 riociguat 的疗效（129 例患者）。总体而言，57.3%的患者为女性，62.6%为功能分级 III 级。平均随访时间为 55.5（26.1）周。女性的心脏指数改善更为显著（平均差值[MD]，0.10L/min/m；95%置信区间[CI]，0.04-0.16；I=0%；P=0.001）。相反，男性肺动脉血管阻力降低的幅度明显高于女性（MD，161.17dynscm；95%CI，67.99-254.35；I=0%；P=0.0007）。
女性和男性对 CTEPH 的 riociguat 或 BPA 可能有不同的血流动力学反应。
