国内卡维地洛与拉贝洛尔治疗轻中度高血压随机对照试验的Meta分析

目的 评价卡维地洛与拉贝洛尔治疗轻中度高血压的疗效与安全性的差异。方法 对国内有关卡维地洛与拉贝洛尔治疗轻中度高血压的随机对照研究资料进行全面调研；在严格的质量评价基础上，利用RevMan4．1软件对7项随机对照临床试验的结果进行Meta分析。根据研究间异质性检验结果，采用相应的模型分析：固定效应模型或随机效应模型。结果 （1）卡维地洛与拉贝洛尔治疗轻中度高血压有效率的合并检验分析，综合检验结果为：Z=2．08，P=0．04，合并OR=1．53，95％可信区间为（1．03，2．29）；（2）敏感性分析显示结果可靠性较好，漏斗图分析结果未发现显著偏倚；（3）两组药物治疗前后舒张压差值的比较综合检验结果：Z=3．02，P=0．002，权重均数差（WMD）=1．65（0．58，2．71）；（4）两组药物治疗前后收缩压差值的比较综合检验结果：Z=0．08，P=0．9，WMD=0．29（-6．66，7．24）；（5）两组药物治疗前后心率差值的比较综合检验结果：Z=0．78，P=0．4，WMD=1．62（-2．46，5．69）；（6）两组不良反应发生率的比较综合检验结果：Z=-1．22，P=0．2，合并OR=0．79，95％可信区间为（0．55，1．15）。结论 卡维地洛治疗轻中度高血压的总有效率高于拉贝洛尔，尤其对舒张压的下降幅度更大；目前国内在治疗轻中度高血压的临床试验中，设计仍不够严谨。

A Meta-analysis on Randomized Controlled Trial of Carvedilol and Labetalol Treatment in Mild and Moderate Hypertension

Objective To evaluate the differences in therapeutic effects and safety between Carvedilol(Ca) and Labetalol(La). Methods All the papers of randomized controlled trials about the treatment of Carvedilol and Labetalol for patients with mild and moderate hypertension were investigated. Meta-analysis was performed by using the statistical software RevMan4.1 on the basis of strict quality evaluation on seven trials of randomized control trial. Two different models,namely,fixed effect model and random effect model,were applied to analyze the results. Results The significant difference in pooled effect of efficiency rate of Carvedilol and Labetalol on patients with mild and moderate hypertension:Z=2.08,P=0.04,the combined OR was 1.53(95%CI, 1.03 to 2.29),sensitivity analysis suggested that the results have a good reliability. No significant publication bias has been found. Significant difference of different value of diastolic pressure in pre- and after treatment between two drugs has been found (Z=3.02,P=0.002), WMD=1.65(0.58, 2.71). No significant difference of different value of systolic pressure and heart rate in pre- and after treatment between two drugs has been found. Conclusions Compared with Labetalol, total efficacy has been enhanced, with significant efficacy in decompression;but the design of the civil studies reported is not entirely science-oriented.