本文選題：肺動(dòng)脈高壓 + 聯(lián)合治療　； 參考：《廣西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:評價(jià)靶向藥物聯(lián)合治療肺動(dòng)脈高壓的有效性及安全性。方法:計(jì)算機(jī)檢索PubMed、Cochrane數(shù)據(jù)庫、中國生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫(CBM)、中國知識資源總庫(CNKI)、萬方等數(shù)據(jù)庫,檢索時(shí)間為數(shù)據(jù)庫建立至2017年4月。納入關(guān)于靶向藥物聯(lián)合治療肺動(dòng)脈高壓的臨床隨機(jī)對照試驗(yàn),并以死亡率、臨床惡化率、WHO功能分級、6分鐘步行試驗(yàn)(6MWD)、血流動(dòng)力學(xué)指標(biāo)(平均肺動(dòng)脈壓力、肺循環(huán)阻力)等作為評價(jià)指標(biāo)。對檢索所得文獻(xiàn)進(jìn)行篩檢,提取相關(guān)數(shù)據(jù),計(jì)數(shù)資料以相對風(fēng)險(xiǎn)比(relative ratio,RR)及其95%可信區(qū)間(confidence interval,CI)表示,計(jì)量資料則以均數(shù)差(mean difference,MD)及其95%CI表示,用RevMan5.3軟件進(jìn)行統(tǒng)計(jì)分析并得出相關(guān)結(jié)果,再對結(jié)果進(jìn)行評價(jià)討論。當(dāng)異質(zhì)性較小時(shí)采用固定效應(yīng)模型,否則采用隨機(jī)效應(yīng)模型。結(jié)果:共納入隨機(jī)對照研究19個(gè),總樣本量4202名患者。META結(jié)果顯示:與單藥治療組相比,聯(lián)合治療組可顯著降低臨床惡化率[RR=0.62,95%CI(0.54,0.70),P0.00001]、提高患者6分鐘步行距離[MD=26.81m,95%CI(14.68,38.95),P0.0001]、提高患者WHO功能分級[RR=1.19,95%CI(1.01,1.40),P0.04]、降低患者平均肺動(dòng)脈壓力[MD=-5.9mmHg,95%CI(-8.48,-3.32),P0.00001],以及肺循環(huán)阻力[MD=-214.74dyn.s-1.cm-5,95%CI(-269.50,-159.97),P0.00001],對于病死率,兩組差異無統(tǒng)計(jì)學(xué)意義(P=0.1)。兩組因各種原因中途退出試驗(yàn)的人數(shù)比例差異有統(tǒng)計(jì)學(xué)意義(P=0.0009),聯(lián)合治療組較單藥治療組高。結(jié)論:根據(jù)本研究,可認(rèn)為靶向藥物聯(lián)合治療較單藥治療后可改善患者的運(yùn)動(dòng)耐量、肺血流動(dòng)力學(xué)指標(biāo),降低臨床惡化的風(fēng)險(xiǎn)。然而,聯(lián)合治療較單藥治療不能降低患者的病死率,并且耐受性欠佳。
[Abstract]:Objective: to evaluate the efficacy and safety of targeted drugs in the treatment of pulmonary hypertension. Methods: the databases of PubMedus Cochrane, Chinese biomedical literature, CNKI and Wanfang were searched by computer. The retrieval time was established until April 2017. A randomized controlled trial was conducted on the combination of targeted drugs in the treatment of pulmonary hypertension. The mortality, the clinical deterioration rate and the WHO functional grading were measured in a 6-minute walking test with a hemodynamic index (mean pulmonary artery pressure, mean pulmonary artery pressure). Pulmonary vascular resistance) was used as evaluation index. The retrieved literature was screened, the relevant data were extracted, the counting data were expressed as relative risk ratio (RR) and its 95% confidence intervalCI, and the measured data were expressed in the mean difference (mean difference) and its 95%CI. RevMan5.3 software is used for statistical analysis and relevant results are obtained, and then the results are evaluated and discussed. When the heterogeneity is small, the fixed effect model is adopted, otherwise the random effect model is adopted. Results: a total of 19 randomized controlled trials were conducted. The total sample size of 4202 patients. Meta results showed that: compared with the single drug treatment group, 鑱斿悎娌葷枟緇勫彲鏄捐憲闄嶄綆涓村簥鎭跺寲鐜嘯RR=0.62,95%CI(0.54,0.70),P0.00001],鎻愰珮鎮(zhèn)ｈ，

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