小剂量阿奇霉素联用辛伐他汀治疗慢性阻塞性肺病合并肺动脉高压的系统评价

目的:系统评价小剂量阿奇霉素联用辛伐他汀治疗慢性阻塞性肺病(COPD)合并肺动脉高压(HP)的临床疗效和安全性。方法：计算机检索PubMed、Medline、CNKI、VIP、万方等数据库,手动检索相关杂志、会议论文及学术论文,收集小剂量阿奇霉素联用辛伐他汀治疗COPD合并HP的临床随机对照研究,检索年限为2000年1月至2016年10月。由2名研究者独立提取数据、评价质量,并交叉核对。采用RevMan 5.2 软件进行Meta分析。结果：共纳入11项研究,943例患者。Meta分析结果显示,剂量阿奇霉素联用辛伐他汀能显著提高COPD合并HP患者FVC MD=0.50,95%CI(0.40,0.61),P<0.01]、FEV1 MD=0.31,95%CI(0.24,0.38),P<0.01]、PaO₂ MD=7.68,95%CI(7.10,8.26),P<0.01]、SaO₂(%) MD=3.89,95%CI(3.29,4.50),P<0.01]、6MWTMD= 77.01, 95%CI(72.88 , 81.14),P<0.01],显著降低平均肺动脉压MD= -1.82,95%CI(- 2.27,- 1.36),P<0.01]和CRPMD= -8.91, 95%CI(-10.42 , -7.39),P<0.01]。两组均未发生严重不良反应。倒漏斗图提示发表偏倚性较小。结论：现有证据表明,小剂量阿奇霉素联用辛伐他汀能显著改善COPD合并肺动脉高压患者肺功能、血氧饱和度和提高活动耐受力,同时显著降低肺动脉压和CRP,且安全可靠。

Meta analysis of low-doses of Azithromycin combined with Simvastatin in the treatment of Chronic Obstructive Pulmonary Disease Combined with Pulmonary Hypertension

OBJECTIVE To systematically review low-dose of azithromycin combined with simvastatin in treatment of chronic obstructive pulmonary disease(COPD) combined with pulmonary hypertension(PH). METHODS Databases including PubMed, Medline, CNKI, VIP and WanFang Data were searched to collect randomized controlled trials (RCTs) about low-dose of azithromycin combined with simvastatin in the treatment of COPD combined with PH from Jan. 2000 to Oct. 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was conducted by RevMan 5.2 software. RESULTS Total of 11 RCTs, 943 patients were included. Meta-analysis showed that, low-dose of azithromycin combined with simvastatin could significantly improve the COPD combined with PH patients in FEV1MD=0.25, 95%CI(0.18, 0.32), P>0.001], SaO₂%MD=3.89, 95%CI(3.29, 4.50), P>0.001], 6MWDMD=76.25, 95%CI(71.95, 80.55, P>0.01], meanwhile significantly reduce in pulmonary hypertensionMD=-1.54, 95%CI(-1.83, -1.24), P>0.001] and CRPMD=-8.86, 95%CI(-10.49, -7.23), P>0.001]. There were no serious adverse reactions in both groups. The inverted funnel plot suggested that the inclusion of the research publication bias was small. CONCLUSION Low-dose of azithromycin combined with simvastatin can improve lung function, dyspnea, the activity tolerancen and reduce pulmonary hypertension in patients with COPD combined with PH.