曲美他嗪聯合美托洛爾治療冠心病伴心力衰竭效果和安全性的系統評價

蔡旭陽 金朝輝 吳斌

[摘要] 目的 系統評價曲美他嗪聯合美托洛爾治療冠心病伴心力衰竭患者的有效性和安全性。 方法 計算機檢索Ovid Medline、EMBase、Cochrane Library、CNKI、CBM、VIP和WanFang Data，檢索時限均從建庫至2018年6月，采用RevMan 5.3軟件對納入研究進行Meta分析。 結果 納入26項隨機對照實驗（RCT），共2691例患者，其中試驗組1346例，對照組1345例。Meta分析結果表明：試驗組左室射血分數改變值（ΔLVEF）[MD = -5.15，95%CI：-5.80～-4.50，P < 0.01]、6 min步行距離改變值（Δ6MWT）[MD = -43.68，95%CI：-55.70～-31.66，P < 0.01]、總有效率[RR = 1.18，95%CI：1.14～1.23，P < 0.01]、左室收縮末期內徑改變值（ΔLVESD）[MD = 5.09，95%CI：4.39～5.79，P < 0.01]、左室舒張末期內徑改變值（ΔLVEDD）[MD = 4.76，95%CI：4.05～5.48，P < 0.01]的效果均優于對照組。試驗組總有效率高于對照組，差異有高度統計學意義（P < 0.01）。兩組藥物不良反應（ADR）發生率比較，差異無統計學意義（P > 0.05）。 結論 曲美他嗪聯合美托洛爾可改善冠心病伴心力衰竭患者的心功能，且不增加安全風險。

[關鍵詞] 曲美他嗪;美托洛爾;冠心病;心力衰竭;系統評價

[中圖分類號] R541? ? ? ? ? [文獻標識碼] A? ? ? ? ? [文章編號] 1673-7210（2019）03（a）-0136-04

[Abstract] Objective To systematically evaluate the efficacy and safety of Trimetazidine combined with Metoprolol in treatment of patients with coronary heart disease complicated with heart failure. Methods Databases including Ovid Medline， EMBase， Cochrane Library， CNKI， CBM， VIP and WanFang Data were retrieved from database foundation to June 2018 by computer. Meta analysis was performed on the included studies by RevMan 5.3 software. Results A total of 26 RCTs involving 2691 cases were included， with 1346 cases in experimental group and 1345 cases in control group. The results of meta-analysis showed： ΔLVEF [MD = -5.15， 95%CI： -5.80--4.50， P < 0.01]， Δ6MWT [MD = -43.68， 95%CI： -55.70--31.66， P < 0.01]， total effective rate [RR = 1.18， 95%CI： 1.14-1.23， P < 0.01]， ΔLVESD [MD = 5.09， 95%CI： 4.39-5.79， P < 0.01 and ΔLVEDD] and ΔLVEDD [MD = 4.76， 95%CI： 4.05-5.48， P < 0.01] of experimental group were statistically better than that of control group. Total effective rate in experimental group was higher than control group， the difference was highly statistically significant （P < 0.01）. There was no statistically significant difference in the incidence of adverse drug reactions （ADR） between two groups （P > 0.05）. Conclusion Trimetazidine combined with Metoprolol can improve the cardiac function of patients with coronary heart disease complicated with heart failure without increasing the incidence of ADR.

[Key words] Trimetazidine; Metoprolol; Coronary heart disease; Heart failure; Systematic review

冠心病是一種心血管疾病，病情發展到晚期易導致多種嚴重并發癥，包括心力衰竭（簡稱“心衰”）、心律失常等。冠心病是心衰最為常見的一種危險因素[1]，嚴重影響了患者生活質量及生命健康。曲美他嗪（TMZ）是一種作用于心肌細胞代謝的新型藥物，能夠改善心血管功能。目前臨床研究發現[2-3]，TMZ聯合美托洛爾（MTP）可減輕冠心病伴心衰患者的心肌缺血情況，改善心衰癥狀。因此，本研究擬通過系統分析聯用TMZ和MTP治療冠心病伴心衰的效果和安全性，為臨床應用提供參考依據。