依那普利叶酸片对比依那普利片治疗心力衰竭的Meta-分析  

Meta-analysis of enalapril folic acid tablets vs enalapril tablets in treatment of heart failure

作　　者：李晓鹃 陈智龙[1] 余强 李振龙[1] 杜高波 LI Xiaojuan;CHEN Zhilong;YU Qiang;LI Zhenlong;DU Gaobo(Department of cardiology of Huangshi Central Hospital of Edong medical group,Huangshi,435002,China)

机构地区：[1]鄂东医疗集团黄石市中心医院心血管内科,湖北黄石435002

出　　处：《药物评价研究》2019年第5期996-1002,共7页Drug Evaluation Research

基　　金：湖北省自然科学基金资助项目(ZRZ2015000316)

摘　　要：目的系统评价依那普利叶酸片对比依那普利片治疗心力衰竭的疗效和安全性,为临床推广提供循证医学证据。方法计算机检索中国学术期刊全文数据库(CNKI)、中国生物医学文献数据库(CBM)、维普中文科技期刊数据库(VIP)、万方医学期刊全文数据库、PubMed及Cochrane library等数据库,收集有关依那普利叶酸片对比依那普利片治疗心力衰竭的随机对照研究(RCT),采用Revman 5.3软件对各研究的N-末端B型利钠肽前体(NT-proBNP)、同型半胱氨酸(Hcy)、血浆和肽素水平、心脏超声指标、ADR等进行分析。结果共纳入12项RCT,1 259例患者。Meta-分析显示:与依那普利片比较,依那普利叶酸片能进一步降低NT-proBNP水平(MD=-0.41,95%CI=-0.43～-0.40,P<0.01)、血浆和肽素水平(MD=-3.02,95%CI=-4.37～-1.68,P<0.01)和Hcy水平(MD=-3.36,95%CI=-4.04～-2.68,P<0.01);显著增加LVEF/%(MD=5.00,95%CI=3.58～6.43,P<0.01),降低LVEDD(MD=-4.07,95%CI=-5.74～-2.40,P<0.01)和LVESDD(MD=-3.49,95%CI=-5.23～-1.76,P<0.01);ADR发生率(OR=1.00,95%CI=0.42～2.36,P>0.05)无显著性差异。结论依那普利叶酸片降低心力衰竭患者NT-proBNP、Hcy和血清和肽素水平,改善心脏功能均优于依那普利片,两种药物安全性相当。Objective To systematically evaluate the efficacy and safety of enalapril folic acid tablets vs enalapril tablets in the treatment of heart failure,and provide evidence-based medical evidence for clinical promotion.Methods The related databases of CNKI,CBM,VIP,Wanfang Database,PubMed and Cochrane library were used to identify studies on the efficacy and safety of enalapril folic acid tablets vs enalapril tablets in the treatment of heart failure.The NT-proBNP,Hcy,serum levels of copeptin,cardiac ultrasound index and ADR of studies were analyzed by the RevMan 5.3 software.Results A total of 12 randomized controlled trials were reviewed,and 1 259 patients were included.Meta-analysis result showed that:compared with enalapril tablets,enalapril folic acid tablets further reduced the levels of NT-proBNP(MD=-0.41,95%CI=-0.43—-0.40,P<0.01),serum levels of copeptin(MD=-3.02,95%CI=-4.37—-1.68,P<0.01)and Hcy levels(MD=-3.36,95%CI=-4.04—-2.68,P<0.01);And it significantly increased LVEF/%(MD=5.00,95%CI=3.58—6.43,P<0.01),and decreased LVEDD(MD=-4.07,95%CI=-5.74—-2.40,P<0.01)and LVESDD(MD=-3.49,95%CI=-5.23—-1.76,P<0.01).The rate of ADR had no significant difference(OR=1.00,95%CI=0.42—2.36,P>0.05).Conclusion Enalapril folic acid tablets can reduce the levels of NT-proBNP,Hcy and serum levels of copeptin,and improve cardiac function in patients with heart failure than that of enalapril tablets.The safety of the two drugs is equivalent.

关 键 词：依那普利叶酸片 依那普利片 心力衰竭 N-末端B型利钠肽前体 同型半胱氨酸 META-分析 

分 类 号：R541.6[医药卫生—心血管疾病]