曲美他嗪治疗扩张型心肌病的Meta分析

背景：曲美他嗪治疗缺血性心脏病的安全性及有效性已有定论,但其对于扩张型心肌病治疗的安全性和有效性评价鲜有报道。 目的：运用Meta分析评价曲美他嗪治疗扩张型心肌病的有效性和安全性。 方法：检索Cochrane临床对照试验中心注册库、Medline数据库、PubMed数据库和CNKI全文数据库、维普全文数据库自建库以来至2009-12公开发表的与曲美他嗪治疗扩张型心肌病相关的文章,并辅以手工检索。英文检索词为“Trimetazidine;Dilated cardiomyopathy”,中文检索词为 “曲美他嗪;扩张型心肌病”。同时,限定文献发表类型为随机对照临床试验。对资料进行初筛,选取针对性强的文章,排除重复研究,同一领域的文献则选择近期发表或权威杂志的文章。对筛选出的文献查找全文。采用RevMan 4.2.2软件对纳入的试验结果进行统计学分析。 结果与结论：纳入6篇随机对照实验研究,共339 例患者,其中高质量研究1篇。Meta分析结果显示,曲美他嗪与对照组相比较,再住院率降低,OR = 0.21(95% CI,0.07~0.59)> 0,Z值为2.98(P = 0.003);死亡率降低OR=0.14(95% CI,0.03-0.69)>0,Z值为2.43(P= 0.01);6 min步行实验曲美他嗪组较对照组步行距离增加,OR=57.27(95% CI,46.17~72.38)> 0,Z值为8.86(P < 0.000 01);左室射血分数结果显示随访终点的曲美他嗪组均高于对照组(常规治疗组)OR=2.44(95% CI,0.89~3.99)> 0,Z值为3.08(P = 0.002);曲美他嗪组明显缩小左室舒张末期内径,OR=-1.42(95% CI,-5.06~-3.18)< 0,Z值为8.57(P < 0.000 01)。研究结果表明曲美他嗪治疗扩张型心肌病是安全有效的。

Meta analysis of trimetazidine in the treatment of dilated cardiomyopathy

BACKGROUND:Trimetazidine has shown safety and efficacy in the treatment of ischemic heart disease, whether it has similar effect on treating dilated cardiomyopathy remains unclear.  OBJECTIVE:To evaluate the efficacy and safety of Trimetazidine in the treatment of dilated cardiomyopathy. METHODS:Cochrane, PubMed, Medline and China National Knowledge Infrastructure (CNKI) databases were searched for the literatures on the clinical trials of Trimetazidine in the treatment of dilated cardiomyopathy using key words of “Trimetazidine, dilated cardiomyopathy”. A manual search of those trials was simultaneously performed. A meta-analysis was conducted on the outcomes of the included trials with the assistance of RevMan 4.2.2 software. RESULTS AND CONCLUSION:Totally 6 of the randomized controlled trials including 339 patients were analyzed, and 1 study was of high methodological quality. Meta-analysis indicated that, compared with control group, the rehospitalization rate of the Trimetazidine group was decreased, OR=0.21(95% CI, 0.07-0.59)> 0, Z value was 2.98 (P=0.003), mortality declined OR=0.14(95% CI, 0.03-0.69)> 0, Z value was 2.43 (P=0.01), and the walking distance increased, OR=57.27(95% CI, 46.17-72.38)> 0, Z value was 8.86 (P < 0.000 01). The left ventricular ejection fraction of the Trimetazidine group was greater the control group (conventional therapy group) at the end of follow-up, OR=2.44(95% CI, 0.89-3.99)> 0, Z value was 3.08 (P < 0.002), and the left ventricular end diastolic diameter was obviously minificated, OR=-1.42 (95% CI, -5.06 to -3.18)< 0, Z value was 8.57 (P < 0.000 01). These findings demonstrated that, it is safe and effective to treat dilated cardiomyopathy using Trimetazidine.