卡维地洛与美托洛尔对糖脂代谢影响的系统性评价

目的系统评价卡维地洛与美托洛尔对糖脂代谢的影响,为临床用药提供参考。方法计算机检索The Cochrane Library、PubMed、Embase、CNKI、VIP、CBMdisc以及万方医学网,收集卡维地洛(试验组)对比美托洛尔(对照组)治疗心血管疾病时对糖脂代谢影响的随机对照研究,提取相关资料并按照改良Jadad评分量表评价纳入研究质量,采用RevMan 5.3软件进行Meta分析。结果共纳入51项随机对照研究,合计4355例患者。Meta分析结果显示,治疗2、3和6月空腹血糖(FPG)分别为(MD=-0.44,95%CI:-0.61^-0.27,P<0.001)、(MD=-0.46,95%CI:-0.61^-0.30,P<0.001)和(MD=-0.37,95%CI:-0.46^-0.27,P<0.001),试验组均较对照组低,且差异均具有统计学意义;试验组2、3和6月FINS和3、6月ISI较对照度低,但2月FINS和6月ISI无显著统计学差异(P>0.05);试验组2、3及6月的总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)低于对照组,除2月TC不具有显著统计学差异(P=0.06),其余均有显著的统计学差异(P<0.05);试验组2、3及6月的高密度脂蛋白胆固醇(HDL-C)高于对照组,均有显著的统计学差异(P<0.05)。亚组分析结果与全组分析基本一致,表明基线糖脂不影响两药对血糖和血脂代谢的影响。结论长期使用(>2月)β受体阻滞剂会影响糖脂代谢,无论基线糖脂水平如何,与美托洛尔相比,卡维地洛显著改善FPG、空腹胰岛素(FINS)、胰岛素敏感指数(ISI)、TC、TG、LDL-C和HDL-C,对糖脂代谢产生有利影响。考虑到纳入部分研究质量较低,存在发表偏倚,期待更多高质量大样本的临床随机对照试验来支持本结论。

A systematic analysis of the effects of carvedilol and metoprolol on glucose and lipid metabolism

Objective To evaluate the effects of carvedilol and metoprolol on glucose and lipid metabolism systematically,and provide evidence-based reference for clinical use.Methods The pertinent randomized controlled trials(RCTs)about carvedilol trail group and metoprolol control group in the treatment of cardiovascular diseases were retrieved from The Cochrane Library,PubMed,Embase,CNKI,VIP,CBMdisc and Wan fang Database.The quality of included studies were evaluated according to modified Jadad quality scale after extracting data.Metaanalysis was performed by using RevMan 5.3 statistical software.Results A total of 51 RCTs were included,involving 4355 patients.The results of Meta-analysis showed that FPG at 2,3 and 6 months was were(MD=-0.44,95%CI:-0.61^-0.27,P<0.001),(MD=-0.46,95%CI:-0.61^-0.30,P<0.001)and(MD=-0.37,95%CI:-0.46^-0.27,P<0.001),respectively The experimental group was lower than the control group,and the differences were statistically significant.Experimental groups 2,3,and 6 mo FINS and 3 and 6mo ISI were lower than the control,but there was no significant difference between 2mo FINS and 6mo ISI(P>0.05).TC,TG,LDL-C of experimental group 2,3 and 6mo were lower than those of control group,There was no significant statistical difference at 2mo TC(P=0.06),and the rest had significant statistical differences(P<0.05).HDL-C in experimental groups 2,3 and 6mo were higher than those in control group,all had significant statistics Difference(P<0.05).The results of the subgroup analysis were basically consistent with the whole group analysis,indicating that the baseline glucose and lipids did not affect the effects of the two drugs on blood glucose and blood lipid metabolism.Conclusion Glycolipid metabolism could be influenced by long-term use(>2 months)of carvedilol and metoprolol.Whatever baseline blood glucose and lipid levels.Compared with metoprolol,carvedilol significantly improved FPG,FINS,ISI,TC,TG,LDL-C and HDL-C,which has a beneficial effect on glycolipid metabolism.On the whole,a few RCTs enrolled in this research were low quality,the conclusion made in this paper needs to be further confirmed by high quality RCTs.