卡维地洛联用螺内酯治疗中国患者慢性心力衰竭的Meta-分析

目的 系统评价卡维地洛联合螺内酯治疗慢性心力衰竭的有效性和安全性。方法 计算机检索PubMed、Cochranelibrary、中国学术期刊全文数据库（CNKI）、中国生物医学文献数据库（CBM）、维普中文期刊全文数据库（VIP）和万方数据库，检索年限为2000年1月至2019年12月，对符合纳入排除标准的随机对照试验（RCT），进行数据提取和偏倚风险评价，然后采用RevMan 5.3软件进行Meta-分析。结果 最终纳入15个RCTs，共1 594例患者。Meta-分析结果显示：卡维地洛联合螺内酯能显著提高临床有效率（RR=1.25，95% CI=1.18~1.32，P<0.01）、降低心率（SMD=-1.58，95% CI=-1.96~-1.21，P<0.01 ）、提高左心室射血分数（SMD=1.22，95% CI=1.04~1.44，P<0.01）和脑钠肽水平（SMD=- 0.79，95% CI=-0.92~-0.65，P<0.01），未增加药物不良反应发生率（RR=1.36，95% CI=0.90~2.06，P=0.14），按照对照组治疗方案不同进行亚组分析结果与上述一致。结论 卡维地洛联合螺内酯治疗慢性心力衰竭的临床疗效优于常规治疗或卡维地洛，而安全性相当。

Meta-analysis of carvedilol combined with spironolactone for chronic heart failure in Chinese patients

Objective To systematically evaluate the effectiveness and safety of carvedilol combined with spironolactone in the treatment of chronic heart failure. Methods Databases of PubMed, Cochrane library, CNKI, CBM, VIP, and Wanfang Database were searched from January 2000 to December 2019, Data extraction and bias risk assessment were performed on randomized controlled trials that met the inclusion exclusion criteria. Meta-analysis was performed using RevMan 5.3 software. Results A total of 15 RCTs involving 1 594 patients were entered. Meta-analysis showed that carvedilol combined with spironolactone could significantly improve clinical effectiveness (RR=1.25, 95% CI=1.18 to 1.32, P<0.01), reduce the heart rate (SMD=-1.58, 95% CI=-1.96 to -1.21, P<0.01), increase left ventricular ejection fraction (SMD=1.22, 95% CI=1.04 to 1.44, P<0.01) and brain natriuretic peptide level (SMD=-0.79, 95% CI=-0.92 to -0.65, P<0.01), and did not increase the incidence of ADR (RR=1.36, 95% CI=0.90 to 2.06, P=0.14). The results of the subgroup analysis according to the treatment plan of the control group were consistent with the above. Conclusion Based on the available evidence, the clinical efficacy of carvedilol combined with spironolactone in chronic heart failure is better than that of conventional treatment or carvedilol with, and and the security is quite.