卡维地洛与美托洛尔对扩张型心肌病疗效比较的Meta分析

目的比较卡维地洛和美托洛尔治疗扩张型心肌病的疗效。方法计算机检索Cochrane图书馆、MEDLINE、EMbase、中国知网、维普数据库、万方数据库和中国生物医学文献数据库,查找自1980年1月至2011年12月公开发表的比较卡维地洛和美托洛尔治疗扩张型心肌病随机对照试验,同时辅以手检纳入文献的参考文献。按纳入排除标准进行筛选、资料提取和质量评价后,使用RevMan5.1软件进行Meta分析。结果共纳入5项研究,347例患者。Meta分析结果显示：与美托洛尔相比,卡维地洛对左心室射血分数的改善有统计学差异（MD=3.93,95%CI：2.30～5.55,P〈0.01）;而对左心室舒张末内径（MD=-1.57,95%CI：-3.71～0.57,P=0.15）、血浆脑钠肽（MD=-69.86,95%CI：-192.33～52.62,P=0.26）、NYHA心功能标准疗效评价（MD=1.24,95%CI：0.21～7.25,P=0.81）等指标的影响均无统计学差异。结论在扩张型心肌病的治疗中,卡维地洛能更显著提高患者左心室射血分数,但其在改善心功能的其他方面,与美托洛尔无明显差异。由于纳入研究数目和质量有限,建议临床审慎参考。

A Meta-analysis on comparison in curative effects of carvedilol and metoprolol on dilated cardiomyopathy

Objective To compare the curative effects of carvedilol and metoprolol on dilated cardiomyopathy.Methods The documents of randomized controlled trials(RCT) about the comparison in treatment of dilated cardiomyopathy with carvedilol and metoprolol published from Jan.1980 to Dec.2011 were retrieved from the databases of Cochrane Library,MEDLINE,EMbase,CNKI,VIP,WANFANG and CMB,and the reference in RCT were retrieved by hands at the same time.The documents were screened,extracted and evaluated according to inclusion and exclusion criteria,and then given a Meta-analysis by using RevMan 5.1 software.Results There were totally 5 RCT(347 patients) included.The results of Meta-analysis showed as follows:compared with metoprolol,the improvement effect of carvedilol on left ventricular ejection fraction(LVEF) had a statistical difference(MD=3.93,95%CI:2.30～5.55,P<0.01),while its influences on left ventricular end-diastolic inner diameter(LVEDd,MD=-1.57,95%CI:-3.71～0.57,P=0.15),plasma brain natriuretic peptide(BNP,MD=-69.86,95%CI:-192.33～52.62,P=0.26) and NYHA-FC(MD=1.24,95%CI:0.21～7.25,P=0.81) had no statistical difference.Conclusion In the treatment of dilated cardiomyopathy,carvedilol is similar to metoprolol except of it can significantly improve LVEF.It is suggested that the study results would be consulted with discretion because of the limitation in the quantity and quality of the study.