尼可地尔与硝酸酯类药物对稳定型心绞痛疗效的Meta分析  

Nicorandil or Nitrates for SAP: A Comparison of Effects and Meta Analysis Based on Randomized Controlled Trials

作　　者：罗碧辉[1,2] 吴平生[1] 曾昭华[2] 卜彤[2] 

机构地区：[1]南方医科大学南方医院心内科,广东省广州市510515 [2]广州医学院第一附属医院心血管内科

出　　处：《中国全科医学》2013年第33期3939-3943,共5页Chinese General Practice

基　　金：国家自然科学基金(81170280);广东省自然科学基金(9151018201000020)

摘　　要：目的本研究应用系统文献回顾和Meta分析方法,立足于随机对照试验(RCT),比较尼可地尔和硝酸酯类药物对稳定型心绞痛临床疗效的异同。方法应用计算机搜索Cochrane临床对照试验注册数据库、PubMed、EMBASE、中国生物医学文献数据库、中国学术期刊全文数据库、万方数据库及维普数据库。收集范围由数据库建立初始至2013年5月,实施比较口服尼可地尔与硝酸酯类药物治疗稳定型心绞痛患者的RCT研究,观察指标包括心绞痛症状改善、心电图改变及头痛发生情况。采用Stata 11.0软件进行Meta分析。结果共检索到34篇文献,最后纳入10篇相关的RCT研究。共计纳入患者872例,尼可地尔组和硝酸酯类药物组各436例。Meta分析结果显示,与加用硝酸酯类药物相比,在降低心绞痛症状发作方面,常规治疗基础上加用尼可地尔更具优势,差异有统计学意义〔OR=1.96,95%CI(1.30,2.96),P=0.001〕;两组药物在改善活动平板心电图ST段压低1 mm需要的时间方面,差异无统计学意义(P=0.877);两组头痛发生率比较,差异无统计学意义(P=0.138)。单因素Meta回归分析显示,性别不是影响心绞痛症状改善和头痛发生的主要因素(P>0.05)。结论在减少心绞痛症状发作方面,常规治疗基础上加用尼可地尔较加用硝酸酯类药物更具优势;两种药物的头痛发生率无显著差异;性别对上述结果无显著影响。Objective To compare the effect of nicorandil with that of nitrates on stable angina pectoris （SAP） based~ on randomized controlled trials （RCT） using a systematic literature review and Meta analysis. Methods The data about nic- orandil and nitrates for SAP were searched in Cochrane Controlled Trials Register, PubMed, EMBASE, CBM, CNKI, WANFANG, and VIP databases to perform a RCT study. Results A total of 34 literatures were retrieved out and 10 RCT litera- tures enrolled in this study; 872 patients were divided into groups nicorandil and nitrates, 436 in each. By Meta analysis, nic- orandil based on conventional treatment was more effective than nitrates in reducing symptoms of angina attacks, the difference was significant [ OR = 1.96, 95% CI （ 1.30, 2. 96）, P = 0. 001], but there was no difference in time for 1 mm ST depression （P = 0. 877） ; There was no difference in headache incidence （P = 0. 138）. By univariate Meta regression analysis, gender was not the main factor influencing SAP symptom improvement or headache occurrence （P 〉 O. 05）. Conclusion The effect of nic- orandil based on conventional treatment is superior to that of nitrates in treatment of SAP. There is no significant difference in headache incidence between 2 groups. Gender does not influence the above results obviously.

关 键 词：尼可地尔 硝酸酯类 心绞痛 META分析 

分 类 号：R541.42[医药卫生—心血管疾病]