曲美他嗪联合麝香保心丸治疗慢性心力衰竭疗效的Meta分析  

Updating the evidence for the effect trimetazidine and shexiang baoxin pills on chronic heart failure:a Meta-analysis

作　　者：杨柳[1] 郭毅[2] 

机构地区：[1]武汉大学医院内科 [2]武汉大学公共卫生学院流行病学教研室

出　　处：《中国临床药理学与治疗学》2014年第6期644-650,共7页Chinese Journal of Clinical Pharmacology and Therapeutics

摘　　要：目的:系统评价常规治疗的基础上加用曲美他嗪联合麝香保心丸治疗慢性心力衰竭的疗效。方法:系统检索Cochrane Library、ProQuest Central、MEDLINE、EMbase、PEDro、OpenSIGLE、National Technical Information Service(NTIS)、ScienceDirect、CNKI、VIP、Wanfang Data、CBM至2013年4月30日。收集常规治疗的基础上加用曲美他嗪联合麝香保心丸治疗慢性心力衰竭的随机对照试验(RCT),按纳入和排除标准由2名评价者独立选择试验提取资料,交叉核对并进行方法学质量评估,对纳入研究的文献采用RevMan5.2软件进行Meta评价。结果:共纳入7项研究451例患者,Meta分析四个主要结局的结果显示:临床疗效改善方面、左心室射血分数改善方面、左室舒张末期内径(LVEDD)改善方面、左室舒张末期容积(LVESD)改善方面、6min步行距离改善方面的比较,其差异均有统计学意义。[WMD(95%CI)分别3.09(2.07,4.59)、5.81(4.69,6.93)、-5.31(-7.19,-3.43)、-4.6(-8.59,-0.64)、42.73(32.48,52.97)],均无不良反应。四个主要结局的倒漏斗图显示左右不对称,提示可能存在发表性偏倚。结论:现有证据显示曲美他嗪联合麝香保心丸治疗慢性心力衰竭的临床疗效及左心室射血分数、左室舒张末期内径、6min步行距离、左室舒张末期容积的改善明显。受纳入文献质量的限制,其治疗慢性心力衰竭疗效的评价期待更多高质量的随机对照双盲研究,以做进一步的评价。AIM： To review the therapeutical effect of trimetazidine and shexiang baoxin pill on chronic heart failure. METHODS. The litera- ture of randomized and controlled trialls（RCT） about treatment of chronic heart failure with trimetazidine and shexiang baoxin pill were retrieved from Cochrane Library, ProQuest Central, MEDLINE, EMbase, PEDro, OpenSI- GLE, NTIS, ScienceDirect, CNKI, VIP, Wan- fang Data and CBM（by Apri 30,2013）, and then 2 reviews independently chose RCT , extracted materials, checked crossly and gave methodolog- ical quality evaluation. Meta analysis was con- ducted by using Revman 5. 2 software. RE- SULTS.A total of 7 trials and 451 patients were discovered . Meta-analyses showed that at the end of the study ,compared with routine remedy alone, the extra remedy of trimetazidine and shexiang baoxin pill on chronic heart failure got abvious amelioration on the improvement of clin- ical efficacy, left ventricular ejection fraction （LVEF）, left ventricular end diastolic diameter（LVEDD）, left ventrieular end diastolic volume （LVEDV） and the walking range of 6 minutes [WMD= （95% CI） 3.09 （2.07,4.59）, WMD = （95%CI）5. 81（4. 69 to 6.93）,WMD=-5.31（-7.19 to -3.43）,WMD=-4.6（-8.59 to - 0. 64）] , WMD= 42. 73 （32. 48 to 52.97）. CON- CLUSION： The existing evidence shows that the therapy of trimetazidine and shexiang baoxin pill is effective to on chronic heart failure and can ameliorate clinical efficacy , left ventricular ejection fraction （LVEF）, left ventricular end diastolic diameter（LVEDD）, left ventricular end diastolic volume（LVEDV） and the walking range of 6 minutes. There were not any adverse reactions . As the limitation of the quality of enclosed literature, the review on the curative effect of chronic heart failure expects more randomized controlled double-blin-ded trials with high quality.

关 键 词：曲美他嗪 麝香保心丸 慢性心力衰竭 META分析 

分 类 号：R311[医药卫生—基础医学]