Meta Analysis Of The Effect Of Angiotensin Ⅱ Receptor Blocker Treating The Patients With Idiopathic Pulmonary Fibrosis

Objective:To analyse the efficacy of angiotensinⅡreceptor blocker in the treatment of patients with idiopathic pulmonary fibrosis by the method of system evaluation.Methods:Relevant literatures were retrieved from PubMed,Medline,the Cochrane library,Embase,the Cochrane trials,CBM,CNKI,VIP and Wangfang with the designed logic retrieval type.The retrieval time period is from the date of establishment of these databases to November 2017.The language of the literature included English and Chinese.Those randomized controlled trial about the angiotensinⅡreceptor antagonist treatment of idiopathic pulmonary fibrosis were included.Then the quality evaluation of the inclusion literature was carried out,and relevant data were extracted,and the data were combined and analyzed with RevMan5.3 software.Results:A total of 15 literature reported the angiotensinⅡreceptor antagonist treatment of idiopathic pulmonary fibrosis,Which were all randomized controlled trials.There were 1,299 patients（male:785,female:514）,of whom 651 were in the ARB treatment group and 648 in the control group.A total of 14 literature reported the efficacy of the angiotensinⅡreceptor antagonist treatment of IPF.Through the Meta Analysis we found that ARB combined treatment group effectiveness was better than that of control group,and the difference was statistically significant（RR=1.31,95%CI:1.22¹.40,Z=7.68,P<0.00001）.The improvement of oxygen partial pressure before and after treatment was reported in a total of eight articles.High heterogeneity was found by that the heterogeneity analysis（I²=93%,P<0.00001）.subgroup analysis was performed through the level of oxygen partial pressurethe（PaO₂<45mmHg group and PaO₂≥45 mmHg group）.The results suggest that the improvement of oxygen partial pressure of ARB treatment group was better than that of control group in the PaO₂≥45mmHg subgroups（MD=12.42,95%CI:11.56¹3.27,Z=28.41,P<0.00001）,while in PaO₂<45 mmHg subgroups,the improvement of oxygen partial pressure of ARB treatment group was better than that of control group too（MD=7.97,95%CI:7.31⁸.63,Z=23.65,P<0.00001）.The improvement of PaCO₂ before and after treatment was reported in a total of five articles.because of the high heterogeneity（I²=94%,P<0.00001）,so subgroup analysis was performed through the level of PaCO₂（PaCO₂≤60mmHg group and PaCO₂>60 mmHg group）.The results indicate:the improvement of PaCO₂ of ARB treatment group was better than that of control group in the PaCO₂≤60mmHg subgroups（MD=﹣15.49,95%CI:17.27¹3.72,Z=17.07,P<0.00001）,while in PaCO₂>60 mmHg subgroups,the improvement of PaCO₂of ARB treatment group was better than that of control group（MD=﹣9.56,95%CI:﹣11.39^﹣7.73,Z=10.24,P<0.00001）.The improvement of the vital capacity（VC）before and after treatment was reported in a total of two articles.Through the data consolidation,we found that ARB treatment group and control group in VC improve degree has no statistical significance（MD=0.32,95%CI:-0.03⁰.67,Z=1.77,P=0.08）.The improvement of the amount of carbon monoxide diffusion（DLco）before and after treatment was reported in a total of two articles.we found that the improvement of the amount of carbon monoxide diffusion of ARB treatment group was better thanthatofcontrolgroup.（MD=28.43,95%CI:20.74³6.12,Z=7.25,P<0.00001）.The improvement of the first second forced expiratory volume（FEV1）before and after treatment was reported in a total of three articles.By the data consolidation,we found that the improvement of the first second forced expiratory volume（FEV1）of the ARB treatment group was betterthanthecontrolgroup（MD=0.72,95%CI:0.66⁰.78,Z=23.64,P<0.00001）.The improvement of the force lung capacity（FVC）before and after treatment was reported in a total of three articles.By the data consolidation,we found that the improvement of the the force lung capacity（FVC）of the ARB treatment group was better than the control groupand（MD=0.64,95%CI:0.56⁰.72,Z=15.80,P<0.00001）.Conclusion:Using ARB drugs can improve the efficiency of IPF patients,and the improvement of its auxiliary indicators（PaO₂,PaCO₂,DLco,FEV₁ and FVC）was better than that of the control group.But because of considering the literature quality,the literature publication bias and the too few samples,We still need more high-quality,multicenter,double-blind,large sample randomized controlled trials to support this conclusion.