拉坦前列腺素與曲伏前列腺素治療原發性開角型青光眼和高眼壓癥有效性和安全性的Meta分析_《中國循證醫學雜志》

作者：

 錢志剛 ¹ , 柯敏 ² , 黃鋼 ¹ , 鄒娟 ¹

1. 襄陽市中心醫院眼科（湖北襄陽?441021）；2. 武漢大學中南醫院眼科（武漢?430071）;

關鍵詞：

拉坦前列腺素曲伏前列腺素原發性開角型青光眼高眼壓癥有效性安全性 Meta分析系統評價

DOI：

10.7507/1672-2531.20110161

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目的　系統評價拉坦前列腺素滴眼液（latanoprost）與曲伏前列腺素滴眼液（travoprost）降眼壓的有效性和安全性。
方法　計算機檢索MEDLINE、EMbase、OVID、CNKI，收集有關拉坦前列腺素與曲伏前列腺素治療原發性開角型青光眼和高眼壓癥的隨機對照試驗（RCT）。由兩名評價員按照納入與排除標準獨立進行文獻篩選、資料提取和質量評價，而后采用RevMan 5.0 軟件進行Meta分析。
結果　共納入13個RCT，合計1 433 例患者。Meta分析結果顯示：① 拉坦前列腺素滴眼液與曲伏前列腺素滴眼液降眼壓效果，在2周時差異有統計學意義［WMD= –1.47，95%CI（–2.62，–0.33）］，而在1個月［WMD= –0.50，95%CI（–1.52，0.52）］和6個月［WMD= –0.12，95%CI（–0.85，0.61）］后兩組降眼壓差異無統計學意義。② 隨訪結束時，曲伏前列腺素組結膜充血發生率高于拉坦前列腺素組，其差異有統計學意義［OR=0.47，95%CI（0.35，0.63）］，但兩組眼部疼痛［OR=0.55，95%CI（0.27，1.12）］和皮膚或虹膜失色素［OR=1.25，95%CI（0.53，2.92）］不良反應發生率差異無統計學意義。
結論　治療原發性開角型青光眼和高眼壓癥，拉坦前列腺素與曲伏前列腺素兩種滴眼液降眼壓效果相似，但曲伏前列腺素組結膜充血不良反應發生率較拉坦前列腺素高。但由于納入研究的方法學質量中等，致使本系統評價結果論證強度不高，因此需要開展更多高質量大規模的臨床隨機對照研究，以便更客觀、全面、正確地評價其療效和安全性。

引用本文： 錢志剛,柯敏,黃鋼,鄒娟. 拉坦前列腺素與曲伏前列腺素治療原發性開角型青光眼和高眼壓癥有效性和安全性的Meta分析. 中國循證醫學雜志, 2011, 11(8): 965-970. doi: 10.7507/1672-2531.20110161 復制

1.	1 Higginbotham EJ, Schuman JS, Goldberg I, et al . One-year, randomized study comparing bimatoprost and timolol in glaucoma and ocular hypertension. Arch Ophthalmol , 2002, 120(10): 1286-1293.
2.	Hedman K, Alm A. A pooled-data analysis of three randomized, double-masked, sixmonth clinical studies comparing the intraocular pressure reducing effect of latanoprost and timolol. Eur J Ophthalmol , 2000, 10(2): 95-104.
3.	Netland PA, Landry T, Sullivan EK, et al . Travoprost compared with latanoprost and timolol in patients with open-angle glaucoma or ocular hypertension. Am J Ophthalmol , 2001, 132(4): 472-484.
4.	van der Valk R, Webers CA, Schouten JS, et al . Intraocular pressure-lowering effects of all commonly used glaucoma drugs: a meta-analysis of randomized clinical trials. Ophthalmology , 2005, 112(7): 1177-1185.
5.	McKee HD, Gupta MS, Ahad MA, et al . First-choice treatment preferences for primary open-angle glaucoma in the United Kingdom. Eye , 2005, 19(8): 923-924.
6.	Parrish RK, Palmberg P, Sheu WP, et al . A comparison of latanoprost, bimatoprost, and travoprost in patients with elevated intraocular pressure: a 12-week, randomized, masked-evaluator multicenter study. Am J Ophthalmol , 2003, 135(5): 688-703.
7.	孔祥梅,孫興懷,孟樊榮. 曲伏前列素滴眼液(速為坦)治療原發性開角型青光眼和高眼壓癥的臨床研究. 中國實用眼科雜志, 2004, 22(11): 877-880.
8.	Dubiner HB, Sircy MD, Landry T, et al . Comparison of the diurnal ocular hypotensive efficacy of travoprost and latanoprost over a 44-hour period in patients with elevated intraocular pressure. Clin Ther , 2004, 26(1): 84-91.
9.	Orzalesi N, Rossetti L, Bottoli A, et al . Comparison of the effects of latanoprost, travoprost, and bimatoprost on circadian intraocular pressure in patients with glaucoma or ocular hypertension. Ophthalmology , 2006, 113(2): 239-246.
10.	Parmaksiz S, Yüksel N, Karabas VL, et al . A comparison of travoprost, latanoprost, and the fixed combination of dorzolamide and timolol in patients with pseudoexfoliation glaucoma. Eur J Ophthalmol , 2006, 16(1): 73-80.
11.	Garcia-Feijoo J, Martinez-de-la-Casa JM, Castillo A, et al . Circadian IOP-lowering efficacy of travoprost 0.004% ophthalmic solution compared to latanoprost 0.005%. Curr Med Res Opin , 2006, 22(9): 1689-1697.
12.	Chen MJ, Chen YC, Chou CK, et al . Comparison of the effects of latanoprost and travoprost on intraocular pressure in chronic angle-closure glaucoma. J Ocul Pharmacol Ther , 2006, 22(6): 449-454.　.
13.	Hepsen IF, Ozkaya E. 24-h IOP control with latanoprost, travoprost, and bimatoprost in subjects with exfoliation syndrome and ocular hypertension. Eye , 2007, 21(4): 453-458.
14.	Koz OG, Ozsoy A, Yarangumeli A, et al . Comparison of the effects of travoprost, latanoprost and bimatoprost on ocular circulation: a 6-month clinical trial. Acta Ophthalmol Scand , 2007, 85(8): 838-843.
15.	Maul E, Carrasco FG, Costa VP, et al . A 6-week, multicenter, randomized, double-masked, parallel-group study comparing travoprost 0.004% to latanoprost 0.005% followed by 6-week, open-label treatment with travoprost 0.004%. Clin Ther , 2007, 29(9): 1915-1923.
16.	Chiselita D, Antohi I, Medvichi R, et al . Comparative analysis of the efficacy and safety of latanoprost, travoprost and the fixed combination timolol-dorzolamide; a prospective, randomized, masked, cross-over design study. Oftalmologia , 2005, 49(3): 39-45.
17.	Whitson JT, Trattler WB, Matossian C, et al . Ocular surface tolerability of prostaglandin analogs in patients with glaucoma or ocular hypertension. J Ocul Pharmacol Ther , 2010, 26(3): 287-292.

1. 1 Higginbotham EJ, Schuman JS, Goldberg I, et al . One-year, randomized study comparing bimatoprost and timolol in glaucoma and ocular hypertension. Arch Ophthalmol , 2002, 120(10): 1286-1293.
2. Hedman K, Alm A. A pooled-data analysis of three randomized, double-masked, sixmonth clinical studies comparing the intraocular pressure reducing effect of latanoprost and timolol. Eur J Ophthalmol , 2000, 10(2): 95-104.
3. Netland PA, Landry T, Sullivan EK, et al . Travoprost compared with latanoprost and timolol in patients with open-angle glaucoma or ocular hypertension. Am J Ophthalmol , 2001, 132(4): 472-484.
4. van der Valk R, Webers CA, Schouten JS, et al . Intraocular pressure-lowering effects of all commonly used glaucoma drugs: a meta-analysis of randomized clinical trials. Ophthalmology , 2005, 112(7): 1177-1185.
5. McKee HD, Gupta MS, Ahad MA, et al . First-choice treatment preferences for primary open-angle glaucoma in the United Kingdom. Eye , 2005, 19(8): 923-924.
6. Parrish RK, Palmberg P, Sheu WP, et al . A comparison of latanoprost, bimatoprost, and travoprost in patients with elevated intraocular pressure: a 12-week, randomized, masked-evaluator multicenter study. Am J Ophthalmol , 2003, 135(5): 688-703.
7. 孔祥梅,孫興懷,孟樊榮. 曲伏前列素滴眼液(速為坦)治療原發性開角型青光眼和高眼壓癥的臨床研究. 中國實用眼科雜志, 2004, 22(11): 877-880.
8. Dubiner HB, Sircy MD, Landry T, et al . Comparison of the diurnal ocular hypotensive efficacy of travoprost and latanoprost over a 44-hour period in patients with elevated intraocular pressure. Clin Ther , 2004, 26(1): 84-91.
9. Orzalesi N, Rossetti L, Bottoli A, et al . Comparison of the effects of latanoprost, travoprost, and bimatoprost on circadian intraocular pressure in patients with glaucoma or ocular hypertension. Ophthalmology , 2006, 113(2): 239-246.
10. Parmaksiz S, Yüksel N, Karabas VL, et al . A comparison of travoprost, latanoprost, and the fixed combination of dorzolamide and timolol in patients with pseudoexfoliation glaucoma. Eur J Ophthalmol , 2006, 16(1): 73-80.
11. Garcia-Feijoo J, Martinez-de-la-Casa JM, Castillo A, et al . Circadian IOP-lowering efficacy of travoprost 0.004% ophthalmic solution compared to latanoprost 0.005%. Curr Med Res Opin , 2006, 22(9): 1689-1697.
12. Chen MJ, Chen YC, Chou CK, et al . Comparison of the effects of latanoprost and travoprost on intraocular pressure in chronic angle-closure glaucoma. J Ocul Pharmacol Ther , 2006, 22(6): 449-454.　.
13. Hepsen IF, Ozkaya E. 24-h IOP control with latanoprost, travoprost, and bimatoprost in subjects with exfoliation syndrome and ocular hypertension. Eye , 2007, 21(4): 453-458.
14. Koz OG, Ozsoy A, Yarangumeli A, et al . Comparison of the effects of travoprost, latanoprost and bimatoprost on ocular circulation: a 6-month clinical trial. Acta Ophthalmol Scand , 2007, 85(8): 838-843.
15. Maul E, Carrasco FG, Costa VP, et al . A 6-week, multicenter, randomized, double-masked, parallel-group study comparing travoprost 0.004% to latanoprost 0.005% followed by 6-week, open-label treatment with travoprost 0.004%. Clin Ther , 2007, 29(9): 1915-1923.
16. Chiselita D, Antohi I, Medvichi R, et al . Comparative analysis of the efficacy and safety of latanoprost, travoprost and the fixed combination timolol-dorzolamide; a prospective, randomized, masked, cross-over design study. Oftalmologia , 2005, 49(3): 39-45.
17. Whitson JT, Trattler WB, Matossian C, et al . Ocular surface tolerability of prostaglandin analogs in patients with glaucoma or ocular hypertension. J Ocul Pharmacol Ther , 2010, 26(3): 287-292.

《中國循證醫學雜志》

拉坦前列腺素與曲伏前列腺素治療原發性開角型青光眼和高眼壓癥有效性和安全性的Meta分析

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《中國循證醫學雜志》

拉坦前列腺素與曲伏前列腺素治療原發性開角型青光眼和高眼壓癥有效性和安全性的Meta分析

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