方法：检索PubMed，EMbase，Cochrane Library，Web of Science，中国期刊全文数据库(CNKI)，中国生物医学文献数据库(CBM)，维普数据库及万方数据库2015-01-01/2020-12-31收录的有关曲伏前列素与噻吗洛尔治疗中国成人POAG的随机对照试验(RCTs)和回顾性队列研究。按照纳入与排除标准筛选文献，用Cochrane风险评估工具对RCTs进行质量评价，用NOS量表对回顾性队列研究进行质量评价。采用Review Manager 5.4软件进行Meta分析并生成加权均数差(WMD)为效应量对比曲伏前列素与噻吗洛尔在视网膜中央动脉(CRA)和睫状后短动脉(PCA)的收缩期峰值血流速度(PSV)、舒张末期血流速度(EDV)及血管阻力指数(RI)、散光度、血浆内皮素-1(ET-1)、血清基质金属蛋白酶(MMP)、房水基质金属蛋白酶抑制因子-2(TIMP-2)、血清TIMP-2中的差异。

结果：共纳入8项RCTs，4项回顾性队列研究，合计1 192例患者。Meta分析结果显示：曲伏前列素组较噻吗洛尔组更能提高CRA和PCA的PSV(WMD=2.40，95CI：2.12～2.68，P<0.00001； WMD=3.76，95%CI：3.30～4.22，P<0.00001)、EDV(WMD=0.81，95%CI：0.70～0.91，P<0.00001； WMD=0.90，95%CI：0.72～1.09，P<0.00001)以及降低CRA和PCA的RI(WMD=-0.07，95%CI：-0.10～-0.04，P<0.00001； WMD=-0.07，95%CI：-0.08～-0.05，P<0.00001)； 曲伏前列素降低散光度(WMD=-1.34，95%CI：-1.62～-1.06，P<0.00001)效果更优； 曲伏前列素较噻吗洛尔更能降低血浆ET-1(WMD=-5.14，95%CI：-7.08～-3.20，P<0.00001)、血清MMP(WMD=-12.48，95%CI：-24.27～-0.69，P=0.04)，而对房水TIMP-2(WMD=-1.40，95%CI：-5.51～2.71，P=0.51)、血清TIMP-2(WMD=1.69，95%CI：-30.03～33.41，P=0.92)的影响差异不明显。

结论：曲伏前列素治疗POAG较噻吗洛尔在改善血流动力学指标以及降低散光度方面更具优势。

METHODS:Randomized controlled trials(RCTs)and cohort studies comparing the related efficacy of travoprost and timolol for POAG were retrieved from PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure(CNKI), Chinese Biomedical Literature Database(CBM), VIP database and Wanfang database. The search time was from January 1, 2015 to December 31, 2020. The literatures were screened according to the inclusion and exclusion criteria. After quality evaluation by Cochrane tools for RCTs and NOS scores for cohort studies, Review Manager 5.4 software was used for Meta-analyses to generate weighed-mean-difference(WMD)as effect size contrasting the efficacy of travoprost and timolol for the peak systolic velocity(PSV), the end diastolic velocity(EDV)and the resistance index(RI)of the central retinal artery(CRA)and the posterior ciliary artery(PCA), astigmatism, the plasma endothelin-1(ET-1), the serum matrix metalloproteinase(MMP), the tissue inhibitor of metalloproteinase-2(TIMP-2)of the aqueous humor and the serum TIMP-2.

RESULTS:Totally 8 RCTs and 4 retrospective cohort studies were included with 1 192 patients.Meta-analysis showed that:compared with timolol group, the travoprost group had greater effect on increasing the PSV(WMD=2.40, 95%CI: 2.12-2.68, P<0.00001; WMD=3.76, 95%CI: 3.30-4.22, P<0.00001)and the EDV(WMD=0.81, 95%CI: 0.70-0.91, P<0.00001; WMD=0.90, 95%CI: 0.72-1.09, P<0.00001)of the CRA and the PCA as well as on decreasing the RI(WMD=-0.07, 95%CI: -0.10 to -0.04, P<0.00001; WMD=-0.07, 95%CI: -0.08 to -0.05, P<0.00001)of the CRA and the PCA; Travoprost was more effective in decreasing astigmatism(WMD=-1.34, 95%CI: -1.62 to -1.06, P<0.00001); Compared with timolol, travoprost could significantly decrease the plasma ET-1(WMD=-5.14, 95%CI: -7.08 to -3.20, P<0.00001)and the serum MMP(WMD=-12.48, 95%CI: -24.27 to -0.69, P=0.04), while no statistically significant differences were found in the TIMP-2 of the aqueous humor(WMD=-1.40, 95%CI: -5.51-2.71, P=0.51)and the serum TIMP-2(WMD=1.69, 95%CI: -30.03-33.41, P=0.92).

CONCLUSION:Compared with timolol, travoprost was more effective in improving hemodynamic indexes and decreasing astigmatism in the treatment of POAG.