硝酸甘油单用与联用治疗不稳定性心绞痛疗效的Meta分析

背景：在治疗不稳定性心绞痛时，联硝酸甘油合用药的疗效是否要优于单用，尚缺乏相关的循证医学证据。 目的：评估硝酸甘油单用与联用治疗不稳定性心绞痛的疗效。 方法：通过计算机和手工系统检索Cochrane图书馆(2010年第2期)、Medline、Embase、Science Direct、SIGLE、GreyNet、中国生物医学文献数据库(CBMdisc)、中文科技期刊全文数据库(VIP)、中国期刊全文数据库(CNKI)和万方数据库，纳入硝酸甘油单用与联用比较用于治疗不稳定性心绞痛的临床随机对照试验，评价其方法学质量后采用RevMan 5.0软件，对其疗效进行Meta分析。 结果与结论：纳入8个单中心临床随机对照试验，共715例患者，方法学质量均为B级。Meta分析结果显示：硝酸甘油联用的临床疗效和心电图疗效优于单独应用(RR =0.79，95%CI：1.56~3.08，P < 0.01；RR =0.72，95%CI：0.64~0.81，P < 0.01)。但上述结果可能存在各种偏倚，建议根据临床症状及循证医学证据选用恰当的联用药物而非滥用。

Nitroglycerin alone and its combination with other drugs for treatment of unstable angina pectoris: A meta-analysis

BACKGROUND:Nitroglycerin is widely used as first-line drug to treat unstable angina pectoris, but the development of tolerance is a major problem that may reduce its clinical efficacy. It has been suggested that the addition of other drugs to nitroglycerin can reverse the development of tolerance, potentiate the hemodynamic response to nitroglycerin and may improve therapy prognosis in unstable angina pectoris. OBJECTIVE:To evaluate whether nitroglycerin combined with drugs show better curative effects than nitroglycerin alone in treatment of unstable angina pectoris. METHODS:A computer-based online search of Cochrane Library, Medline(ovid), EMbase, Science direct, SIGLE, GreyNet, CBMdisc, VIP, CNKI and Wanfang Data for the clinical randomized controlled trials (RCTs) of nitroglycerin alone and its combination of drugs for treating unstable angina pectoris. Hand searching was also done to obtain any further information about the studies. After the quality of RCTs was evaluated, a meta-analysis was performed by RevMan 5.0.0 for clinical and electrocardiogram (ECG) efficacy. RESULTS AND CONCLUSION:A total of eight RCTs about 715 patients were included, the quality of RCTs are all B level. Meta-analysis indicates that nitroglycerin combined with other drugs is superior to nitroglycerin alone in terms of clinical and ECG efficacy in treating unstable angina pectoris (RR = 0.79, 95%CI: 1.56-3.08, P < 0.01; RR = 0.72, 95%CI: 0.64-0.81, P < 0.01). However, various biases may exist in the above results, so the combined drugs should be chosen according to clinical symptoms and evidence-based guidelines.