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祛痰/抗氧化药物治疗COPD疗效与安全性的网状Meta分析
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| 篇名： | 祛痰/抗氧化药物治疗COPD疗效与安全性的网状Meta分析 |
| TITLE： | Efficacy and Safety of Expectorant/antioxidants in the Treatment of COPD ：Network Meta-analysis |
| 摘要： | 目的：系统评价祛痰/抗氧化药物治疗慢性阻塞性肺疾病（COPD）的疗效与安全性，为临床用药提供循证参考。方法：计算机检索PubMed、Embase、Cochrane图书馆、WebofScience、中国生物医学文献数据库、中国知网、维普网、万方数据等，收集祛痰/抗氧化药物（试验组）对比安慰剂（对照组）治疗COPD的随机对照试验（RCT），检索时限均为各数据库建库起至2021年5月。筛选文献、提取资料后采用Cochrane系统评价员手册5.1.0推荐的偏倚风险评价工具对纳入文献进行质量评价，采用Gemtc14.3软件进行一致性检验，采用Stata15.1软件进行网状Meta分析和聚类分层排序，采用倒漏斗图进行发表偏倚分析。结果：共纳入12项RCT，共计4637例患者，共涉及低剂量N-乙酰半胱氨酸（NAC）、高剂量NAC、羧甲司坦、厄多司坦、安慰剂等5种干预措施。网状Meta分析结果显示，在年急性加重率方面，试验组使用高剂量NAC[MD＝－0.45，95％CI（－0.74，－0.17），P＜0.05]、羧甲司坦[MD＝－0.59，95％CI（－0.86，－0.32），P＜0.05]、厄多司坦[MD＝－0.26，95％CI（－0.51，－0.01），P＜0.05]患者的年急性加重率均显著低于对照组，试验组使用高剂量NAC[MD＝－0.55，95％CI（－0.98，－0.11），P＜0.05]、羧甲司坦[MD＝－0.69，95％CI（－1.11，－0.26），P＜0.05]患者的年急性加重率均显著低于低剂量NAC，其余各组组间比较差异无统计学意义（P＞0.05）；网状Meta的概率累积排序结果（以曲线下面积计）为羧甲司坦＞高剂量NAC＞厄多司坦＞安慰剂＞低剂量NAC。在不良事件发生率方面，各组组间比较差异均无统计学意义（P＞0.05）；网状Meta的概率累积排序结果（以曲线下面积计）为厄多司坦＞高剂量NAC＞低剂量NAC＞安慰剂＞羧甲司坦。聚类分层排序结果显示，5种干预措施的疗效与安全性可聚为3类，其中疗效与安全性均较低的安慰剂和低剂量NAC为一类，疗效好但安全性低的羧甲司坦为一类，疗效与安全性均较好的高剂量NAC和厄多司坦为一类。发表偏倚结果显示，以年急性加重率为指标时，本研究存在发表偏倚的可能性较大，以不良事件发生率为指标时，本研究存在发表偏倚的可能性较小。结论：NAC、羧甲司坦、厄多司坦均可降低COPD患者的年急性加重率，且不会增加不良事件发生率。在年急性加重率方面，以羧甲司坦的效果最优；在安全性方面，以厄多司坦最好。高剂量NAC、厄多司坦的疗效与安全性均较好。 |
| ABSTRACT： | OBJECTIVE：To systematically e valuate the efficacy and safety of expectorant/antioxidants in the treatment of chronic obstructive pulmonary disease （COPD），and to provide evidence-based reference for clinical use. METHODS ：Retrieved from PubMed ，Embase，Cochrane Library ，Web of Science ，CBM，CNKI，VIP，Wanfang database ，etc.，randomized controlled trials（RCTs）about expectorant/antioxidants （trial group ）versus placebo （control group ）in the treatment of COPD were collected during the inception to May 2021. After literature screening and data extraction ，the quality of included literatures were evaluated with risk bias evaluation tool recommended by Cochrane systematic evaluator manual 5.1.0. The consistency check was performed by using Gemtc 14.3 software；network Meta-analysis ，clustering and hierarchical sorting were performed with Stata 15.1 software. The publication bias was analyzed by inverted funnel plot. RESULTS ：A total of 12 RCTs，involving 4 637 patients，were included. Five interventions measures were involved ，such as low-dose N-acetylcysteine （NAC），high-dose NAC ，carbo- cisteine， erdosteine and placebo. The results of network Meta-analysis showed that in terms of annual acute aggrava- tion rate ，the patients receiving high-do se NAC [MD ＝－0.45， 163.com 95％CI（－0.74，－0.17），P＜0.05]，carbocisteine [MD ＝－0.59，95％CI（－0.86，－0.32），P＜0.05] and erdosteine [MD ＝－0.26，95％CI（－0.51，－0.01），P＜0.05] in trial group were significantly lower than those in control group ；the annual acute aggravation rate of patients receiving high-dose NAC[MD ＝－0.55， 95％CI（－0.98，－0.11），P＜0.05] and carbocisteine [MD ＝－0.69，95％CI（－1.11，－0.26），P＜0.05] in trial group were significantly lower than those receiving low-dose of NAC ，there was no statistical significance among other groups （P＞0.05）； probability cumulative ranking results （calculated by the area under the curve ）of its network Meta-analysis was carbocisteine ＞ high-dose NAC ＞erdosteine＞placebo＞low-dose NAC. In terms of the incidence of ADR ，there was no statistical significance among groups （P＞0.05）；probability cumulative ranking results （calculated by the area under the curve ） of its network Meta-analysis was erdosteine ＞high-dose NAC ＞low-dose NAC ＞placebo＞carbocisteine. The results of clustering and hierarchical ranking showed that the efficacy and safety of the five interventions could be grouped into three categories ，including placebo and low-dose NAC with low efficacy and safety ，carbocisteine with good efficacy but low safety ，and high-dose NAC and erdosteine with good efficacy and safety. The results of publication bias showed that taking the annual acute exacerbation rate as the index ， there was a greater possibility of publication bias in this study ；taking the incidence of adverse event as index ，there was little possibility of publication bias in this study. CONCLUSIONS ：NAC，carbocisteine and erdosteine all can reduce the annual acute aggravation rate and have low incidence of ADR. Carbocisteine is the best in terms of annual acute aggravation rate ，erdosteine is the best in terms of safety. High-dose NAC and erdosteine are both better in term of efficacy and safety. |
| 期刊： | 2021年第32卷第22期 |
| 作者： | 付延鑫，戴昂，董亮，宁康 |
| AUTHORS： | FU Yanxin ，DAI Ang，DONG Liang，NING Kang |
| 关键字： | 祛痰/抗氧化药物；慢性阻塞性肺疾病；疗效；安全性；网状Meta分析；聚类分层排序 |
| KEYWORDS： | Expectorant/antioxidants；Chronic obstructive pulmonary disease ；Efficacy；Safety；Network Meta-analysis ； |
| 阅读数： | 368 次 |
| 本月下载数： | 31 次 |
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