伊伐布雷定治疗稳定型心绞痛疗效的Meta分析

目的系统评价伊伐布雷定治疗稳定型心绞痛的有效性和安全性。方法在中国学术期刊全文数据库(CNKI)(1997²014.4)、万方数据库(19892014.4)、万方数据库(1989²014.4)、EMBASE(19742014.4)、EMBASE(1974²014.4)、PUBMED(19662014.4)、PUBMED(1966²014.4)数据库检索有关伊伐布雷定治疗稳定型心绞痛的随机对照试验文献,观察组应用伊伐布雷定治疗,对照组应用常规药物,以静息和运动时最大心率下降值、ST段压低1 mm阈值、运动时最高血压值和运动持续时间等5个方面的加权均数差(WMD)为疗效指标,以2组发生不良反应的相对危险度(RR)为安全性指标进行Meta分析。结果共纳入8项随机对照临床试验,包括4 582例患者,其中观察组2439例,对照组2 143例。分析结果显示,观察组静息心率下降值优于对照组(WMD=4.83,95%CI 2.392014.4)数据库检索有关伊伐布雷定治疗稳定型心绞痛的随机对照试验文献,观察组应用伊伐布雷定治疗,对照组应用常规药物,以静息和运动时最大心率下降值、ST段压低1 mm阈值、运动时最高血压值和运动持续时间等5个方面的加权均数差(WMD)为疗效指标,以2组发生不良反应的相对危险度(RR)为安全性指标进行Meta分析。结果共纳入8项随机对照临床试验,包括4 582例患者,其中观察组2439例,对照组2 143例。分析结果显示,观察组静息心率下降值优于对照组(WMD=4.83,95%CI 2.39⁷.28,P=0.000 1);运动最大心率下降值优于对照组(WMD=7.22,95%CI2.607.28,P=0.000 1);运动最大心率下降值优于对照组(WMD=7.22,95%CI2.60¹1.85,P=0.002);ST段压低1 mm阈值优于对照组(WMD=12.04,95%CI 2.8411.85,P=0.002);ST段压低1 mm阈值优于对照组(WMD=12.04,95%CI 2.84²1.25,P=0.01);运动持续时间优于对照组(WMD=31.80,95%CI 25.7621.25,P=0.01);运动持续时间优于对照组(WMD=31.80,95%CI 25.76³7.84,P<0.01);运动时血压最高值与对照组无显著差异(StdWMD=0.02,95%CI-0.5237.84,P<0.01);运动时血压最高值与对照组无显著差异(StdWMD=0.02,95%CI-0.52⁰.56,P=0.93);观察组不良反应发生率与对照组有显著差异(RR=2.43,95%CI1.330.56,P=0.93);观察组不良反应发生率与对照组有显著差异(RR=2.43,95%CI1.33⁴.45,P=0.004)。结论伊伐布雷定治疗稳定型心绞痛疗效好,且安全性好,值得临床应用。

A Meta-analysis of efficacy and safty of trimetazidine in treatment of patients with stable angina pectoris

Objective System evaluation of ivabradine ~s effective and salty in treatment of stable angina pectoris. Methods From Chinese academic journal full text database （CNKI） （1997-2014.4）, Wanfang database （1989-2014. 4）, EMBASE （1974-2014.4）, PUBMED （1966-2014.4） database retrieval of ivabradine randomized controlled trials on the treatment of stable angina pectoris, the observation group application of ivabradine therapy, the control group application of conventional drugs, with rest and maximum heart rate during exercise, the decreased value of ST segment depression in 1 mm threshold, the value and the movement exercise hypertension duration weighted 5 aspects of the weighted mean difference （WMD） as indicators of efficacy, the relative risk （RR） of adverse reactions in 2 groups as the safety index to perform the Meta-analysis. Results A total of 8 randomized controlled clinical trials were included, including 4 582 patients, including 2 439 cases in observation group, 2 143 cases in the control group. The results showed that, the observation group resting heart rate decrease obviously than that in the control group （ WMD = 4.83, 95% CI 2.39 - 7.28, P = 0. 000 1 ） ; motion maximum heart rate decrease obviously than that in the control group （WMD =7.22, 95% CI 2.60 -11.85, P =0. 002） ; ST segment depression in 1 mm threshold is better than that of the control group （ WMD = 12.04, 95% CI 2.84 - 21.25 ,P = 0.01 ） ; exercise duration better than the control group （WMD = 31.80, 95% CI 25.76 - 37.84, P 〈 0.01 ） ; exercise blood pressure with the highest value of the Control group had no significant difference （ StdWMD = 0.02,95% CI - 0.52 - 0.56, P = 0.93 ） ; there were no significant difference of adverse reaction between the observation group and the control group （ RR = 2.43, 95% CI 1.33 - 4.45, P = 0.004）. Conclusion Ivabradine in the treatment of stable angina pectoris is well, as well the safety, worthy of clinical application.