朱思奕 崔翰斌

【摘要】 目的：探讨β受体阻滞剂剂量与急性冠脉综合征患者预后关系。方法：计算机检索PubMed、Cochrane Library、Embase等英文数据库中公开发表的探讨β受体阻滞剂剂量与急性冠脉综合征患者预后关系的相关观察性研究，检索时限为建库至2019年12月。同时采用“滚雪球”法手工检索纳入文献的参考文献。使用纽卡斯尔-渥太华NOS工具对纳入文献进行质量评价。对符合质量标准的文献进行数据提取，采用Review Manager 5.3软件进行Meta分析。结果：最终纳入6篇队列研究。Meta分析结果显示β受体阻滞剂可以更好地降低急性冠脉综合征患者死亡风险[RR=0.50， 95%CI（0.29， 0.86）， P=0.01]。使用≥50%目标剂量与主要心脏不良事件及死亡风险降低有关[RR=0.70， 95%CI （0.54， 0.91）， P=0.007]。100%目标剂量组与50%目标剂量组在观察终点方面差异无统计学意义[RR=0.89， 95%CI（0.59， 1.34）， P=0.57]。结论：50%目标剂量可能是β受体阻滞剂改善急性冠脉综合征患者预后的剂量转折点。

【关键词】 β受体阻滞剂 剂量 急性冠脉综合征 预后

Correlation between Beta-blocker Dose and Prognosis in Patients with Acute Coronary Syndrome： the Meta-analysis Based on Observational Studies/ZHU Siyi， CUI Hanbin. //Medical Innovation of China， 2021， 18（01）： -151

[Abstract] Objective： To investigate the relationship between beta blocker dose and prognosis in patients with acute coronary syndrome. Method： Computer retrieval of observational studies on the relationship between beta blocker dose and prognosis of patients with acute coronary syndrome published in English databases such as PubMed， Cochrane Library and Embase were conducted， and the retrieval time was set up until December 2019. At the same time， the “snowball” method was used to manually retrieve the references of the included literature. The Newcastle-Ottawa NOS tool was used to evaluate the quality of the included literature. The datas were extracted from literatures meeting quality standards， and Meta-analysis was conducted using Review Manager 5.3 software. Result： Finally， 6 cohort studies were included. Meta-analysis showed that beta blockers could reduce the risk of death in patients with ACS [RR=0.50， 95%CI（0.29， 0.86）， P=0.01]. The use of ≥50% target dose was associated with reduced risk of major adverse cardiac events and death [RR=0.70， 95%CI（0.54， 0.91）， P=0.007]. However， there was no significant difference between the 100% target dose group and the 50% target dose group [RR=0.89， 95%CI（0.59， 1.34）， P=0.57]. Conclusion： The target dose of 50% may be the turning point for beta blockers to improve the prognosis of patients with acute coronary syndrome.

[Key words] Beta blockers Dose Acute coronary syndrome Prognosis

First-authors address： Ningbo University School of Medicine， Ningbo 315211， China

doi：10.3969/j.issn.1674-4985.2021.01.036

急性冠脈综合征包括不稳定性心绞痛、非ST段抬高性心肌梗死和ST段抬高性心肌梗死，急性心肌梗死是急性冠脉综合征中最严重的一种。β受体阻滞剂是急性冠脉综合征患者的关键性治疗药物，能够改善预后。改善预后的机制可能有：一是通过降低交感神经张力抑制心肌收缩力、减慢心率、降低血压，减少心肌耗氧，并延长心脏舒张期，增加冠状动脉血供，减少运动状态心肌缺血发作;二是通过减少儿茶酚胺释放，减少致命性心律失常、心脏性猝死及其他心血管事件的发生[1-3]。临床试验和观察性研究结果表明使用β受体阻滞剂可以降低急性冠脉综合征患者主要心脏不良事件（major adverse cardiac events， MACE）的发生及长期死亡率[4-11]。……