吸入一氧化氮治疗纤维化和晚期间质性肺病：随机对照试验的系统评价和荟萃分析
Inhaled nitric oxide in fibrotic and advanced interstitial lung disease: A systematic review and meta-analysis of randomized controlled trials.
摘要(中文译文)
间质性肺疾病（ILD）可导致肺动脉高压（PH），进而造成ILD患者运动能力下降。吸入一氧化氮（iNO）可降低肺动脉压和肺血管阻力，可能改善该人群的运动能力；然而，现有证据仍然有限。因此，我们开展了一项系统评价和荟萃分析，比较iNO与安慰剂在ILD患者中的疗效和安全性。我们系统检索了PubMed、Embase、Cochrane数据库和ClinicalTrials.gov，纳入比较iNO与安慰剂在ILD患者中应用的随机对照试验（RCT）。主要终点为6分钟步行距离（6MWD）。次要终点为中高强度体力活动（MVPA）。安全性终点为任何不良事件。连续型终点采用均数差（MD）或标准化均数差（SMD）报告，二分类终点采用风险比（RR）报告，均附95%置信区间（CI）。共分析4项RCT（包括1项交叉试验），纳入274例患者，其中172例接受iNO治疗。中位随访期为12周。在汇总分析中，与安慰剂相比，iNO对6MWD可能几乎没有影响（MD 1.83m；95% CI -12.98至16.64；p = 0.81），对任何不良事件（RR 1.12；95% CI 0.97至1.30；p = 0.12）和MVPA（SMD 0.32；95% CI -0.93至1.56；p = 0.39）可能也几乎没有影响。iNO未显示出对6MWD或MVPA的改善。这些发现不支持在该人群中常规使用iNO。
Abstract
Interstitial lung disease (ILD) can lead to pulmonary hypertension (PH), contributing to reduced exercise capacity in patients with ILD. Inhaled nitric oxide (iNO) reduces pulmonary artery pressure and pulmonary vascular resistance and may improve exercise capacity in this population; however, the available evidence remains limited. Therefore, we conducted a systematic review and meta-analysis to compare the efficacy and safety of iNO versus placebo in patients with ILD. We systematically searched PubMed, Embase, Cochrane databases, and ClinicalTrials.gov for randomized controlled trials (RCTs) comparing iNO with placebo in patients with ILD. The primary endpoint was 6-minute walk distance (6MWD). Secondary endpoint was moderate-to-vigorous physical activity (MVPA). Safety endpoint was any adverse events. Continuous endpoints were reported using mean differences (MDs) or standardized mean differences (SMDs), and binary endpoints were reported using risk ratios (RRs), all with 95% confidence intervals (CIs). Four RCTs, including one crossover trial, enrolling 274 patients were analyzed. Of these, 172 received iNO. The median follow-up period was 12 weeks. In the pooled analyses, iNO likely results in little to no difference in 6MWD compared with placebo (MD 1.83m; 95% CI -12.98 to 16.64; p = 0.81), and may result in little to no difference in any adverse events (RR 1.12; 95% CI 0.97 to 1.30; p = 0.12) and MVPA (SMD 0.32; 95% CI -0.93 to 1.56; p = 0.39). INO did not demonstrate improvements in 6MWD or MVPA. These findings do not support routine use of iNO in this population.
如何引用
AMA
Shun Nakahara, Yusuke Hirao, Bradley Fujiuchi, Brent Matsuda. Inhaled nitric oxide in fibrotic and advanced interstitial lung disease: A systematic review and meta-analysis of randomized controlled trials.. PloS one. 2026; doi:10.1371/journal.pone.0351862.
APA
Shun Nakahara, Yusuke Hirao, Bradley Fujiuchi, Brent Matsuda (2026). Inhaled nitric oxide in fibrotic and advanced interstitial lung disease: A systematic review and meta-analysis of randomized controlled trials.. PloS one. https://doi.org/10.1371/journal.pone.0351862
GB/T 7714
Shun Nakahara, Yusuke Hirao, Bradley Fujiuchi, Brent Matsuda. Inhaled nitric oxide in fibrotic and advanced interstitial lung disease: A systematic review and meta-analysis of randomized controlled trials.[J]. PloS one, 2026 doi:10.1371/journal.pone.0351862.
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