蔡旭阳 金朝辉 吴斌

[摘要] 目的 系统评价曲美他嗪联合美托洛尔治疗冠心病伴心力衰竭患者的有效性和安全性。 方法 计算机检索Ovid Medline、EMBase、Cochrane Library、CNKI、CBM、VIP和WanFang Data，检索时限均从建库至2018年6月，采用RevMan 5.3软件对纳入研究进行Meta分析。 结果 纳入26项随机对照实验（RCT），共2691例患者，其中试验组1346例，对照组1345例。Meta分析结果表明：试验组左室射血分数改变值（ΔLVEF）[MD = -5.15，95%CI：-5.80～-4.50，P < 0.01]、6 min步行距离改变值（Δ6MWT）[MD = -43.68，95%CI：-55.70～-31.66，P < 0.01]、总有效率[RR = 1.18，95%CI：1.14～1.23，P < 0.01]、左室收缩末期内径改变值（ΔLVESD）[MD = 5.09，95%CI：4.39～5.79，P < 0.01]、左室舒张末期内径改变值（ΔLVEDD）[MD = 4.76，95%CI：4.05～5.48，P < 0.01]的效果均优于对照组。试验组总有效率高于对照组，差异有高度统计学意义（P < 0.01）。两组药物不良反应（ADR）发生率比较，差异无统计学意义（P > 0.05）。 结论 曲美他嗪联合美托洛尔可改善冠心病伴心力衰竭患者的心功能，且不增加安全风险。

[关键词] 曲美他嗪;美托洛尔;冠心病;心力衰竭;系统评价

[中图分类号] R541          [文献标识码] A          [文章编号] 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，病情发展到晚期易导致多种严重并发症，包括心力衰竭（简称“心衰”）、心律失常等。冠心病是心衰最为常见的一种危险因素[1]，严重影响了患者生活质量及生命健康。曲美他嗪（TMZ）是一种作用于心肌细胞代谢的新型药物，能够改善心血管功能。目前临床研究发现[2-3]，TMZ联合美托洛尔（MTP）可减轻冠心病伴心衰患者的心肌缺血情况，改善心衰症状。因此，本研究拟通过系统分析联用TMZ和MTP治疗冠心病伴心衰的效果和安全性，为临床应用提供参考依据。