摘要
目的 系统评价慢性阻塞性肺疾病(COPD)患者应用三联疗法[吸入糖皮质激素(ICS)/长效抗胆碱能药物(LAMA)/长效β2受体激动剂(LABA)]与LAMA/LABA联合疗法的有效性和安全性。方法 检索PubMed、Web of Science、Embase、Cochrane Library数据库中有关三联疗法与LAMA/LABA联合疗法治疗COPD的随机对照试验(RCT)文献,检索时间截至2024年3月,对数据采用Comprehensive Meta-Analysis 2.0(CMA2)软件进行Meta分析。结果 共9项关于ICS附加方案的RCT(N=17 599)入选本Meta分析。与LAMA/LABA相比,三联疗法降低了急性加重的发生率(RR 0.842,95%CI 0.749~0.946),改善了生活质量(QOL)评分和第1秒用力呼气容积(FEV1)谷值,降低了死亡率(OR 0.756,95%CI 0.610~0.936),而肺炎发生率更高(OR 1.436,95%CI 1.233~1.673)。结论 对于有症状的中重度且有急性加重病史的COPD患者,三联疗法导致肺炎的发生率高于LAMA/LABA,但由于急性加重的发生率较低、FEV1谷值较高和QOL评分较好,三联疗法仍是一种更可取的治疗方法。但在选择三联疗法时,医师需要综合考虑患者的具体情况,包括病情的严重程度、急性加重的诱因以及对肺炎的潜在风险。
Objective To systematically evaluate the efficacy and safety of applying triple therapy [inhaled corticosteroids(ICS)/long-acting muscarinic anticholinergics(LAMA)/long-acting beta 2-agonists(LABA)] with LAMA/LABA combination therapy in patients with chronic obstructive pulmonary disease(COPD).Methods A retrieval for randomized controlled trials(RCTs) of triple therapy versus LAMA/LABA combination therapy for COPD was performed in PubMed,Embase,and Cochrane Central Register of Controlled Trials as of March 2024.Meta-analysis of data was performed using CMA 2.0 software.Results A total of 9 RCTs(N=17 599) on ICS add-on regimens were enrolled in this Meta-analysis.Triple therapy significantly reduced the incidence of acute exacerbations(RR 0.842,95%CI 0.749-0.946) and improved quality of life(QOL) scores and trough forced expiratory volume in the first second(FEV1) compared with LAMA/LABA.In addition,triple therapy significantly improved mortality(OR 0.756,95%CI 0.610-0.936).However,the incidence of pneumonia was significantly higher with triple therapy(OR 1.436,95%CI 1.233-1.673).Conclusions In symptomatic patients with moderate and severe COPD with a history of acute exacerbations,triple therapy resulted in a higher incidence of pneumonia than LAMA/LABA,but triple therapy remains a preferable treatment due to the lower incidence of exacerbations,higher trough FEV1 values,and better QOL scores.However,when choosing triple therapy,physicians need to consider the patient's specific situation,including the severity of the disease,acute exacerbation triggers,and the potential risk of pneumonia.
作者
赵惠敏
薛兵
李秀业
杨霁
吴文杰
ZHAO Huimin;XUE Bing;LI Xiuye;YANG Ji;WU Wenjie(Department of Pulmonary and Critical Care Medicine,Beijing Chuiyangliu Hospital,Beijing 100022,China)
出处
《中国医药指南》
2024年第19期78-82,共5页
Guide of China Medicine
关键词
慢性阻塞性肺疾病
急性加重
吸入糖皮质激素
死亡率
肺炎
Chronic obstructive pulmonary disease
Acute exacerbations
Inhaled corticosteroid
Mortality
Pneumonia
