琥珀酸美托洛尔缓释片与酒石酸美托洛尔片治疗慢性心力衰竭临床疗效的 Meta 分析

摘要

目的：评价琥珀酸美托洛尔缓释片与酒石酸美托洛尔片治疗慢性心力衰竭的临床疗效。方法计算机检索 PubMed、中国知网（CNKI）、维普网（VIP）、万方数据知识服务平台等数据库，检索时间为2000年1月—2016年4月，筛选有关琥珀酸美托洛尔缓释片与酒石酸美托洛尔片治疗慢性心力衰竭临床疗效的随机对照试验（RCT），其中琥珀酸美托洛尔缓释片组（MS 组）患者予以琥珀酸美托洛尔缓释片治疗，酒石酸美托洛尔片组（MT 组）患者予以酒石酸美托洛尔片治疗；采用 Rev Man 5.2统计学软件进行 Meta 分析。比较两组患者临床疗效、不良反应发生率、脑尿钠肽（BNP）、左心室射血分数（LVEF）、左心室舒张末期内径（LVEDD）、左心室收缩末期内径（LVESD）。结果共纳入11篇文献，包括1150例患者。Meta 分析结果显示，MS 组患者临床疗效优于 MT 组〔 RR =1.17，95% CI （1.10，1.24），P ﹤0.00001〕，不良反应发生率〔 RR =0.52，95% CI（0.38，0.71），P ﹤0.0001〕低于 MT 组， LVEDD〔MD =-3.96，95% CI（-5.23，-2.68），P ﹤0.00001〕、LVESD〔 MD =-4.39，95% CI（-6.85，-1.92），P =0.0005〕小于 MT 组，LVEF 高于 MT 组〔RR =4.96，95% CI（4.25，5.66），P ﹤0.00001〕。结论琥珀酸美托洛尔缓释片治疗慢性心力衰竭的临床疗效和安全性优于酒石酸美托洛尔片，在改善患者心功能方面优势明显。%Objective To compare the clinical effect of metoprolol succinate sustained - release tablets versus metoprolol tartrate tablets in treating chronic heart failure. Methods Computer was used to screen the RCTs about clinical effect of metoprolol succinate sustained - release tablets versus metoprolol tartrate tablets in treating chronic heart failure in PubMed, CNKI,VIP and Wangfang Data,the RCTs were reported from January 2000 to April 2016. Of the RCTs,patients of A group received metoprolol succinate sustained - release tablets,while patients of B group received metoprolol tartrate tablets. Rev Man 5. 2 statistical software was used to conduct the meta - analysis;clinical effect,incidence of adverse reactions,BNP,LVEF, LVEDD and LVESD were compared between the two groups. Results A total of 11 RCTs were involved in the meta - analysis, including 1 150 patients. Meta - analysis results showed that,clinical effect of A group was statistically statistically significantly better than that of group〔RR = 1. 17,95% CI(1. 10,1. 24),P ﹤ 0. 000 01〕,incidence of adverse reactions〔RR = 0. 52, 95% CI(0. 38,0. 71),P ﹤ 0. 000 1〕of A group was statistically significantly lower than that of B group,LVEDD〔 MD= - 3. 96,95% CI( - 5. 23, - 2. 68),P ﹤ 0. 000 01〕 and LVESD〔 MD = - 4. 39,95% CI( - 6. 85, - 1. 92),P= 0. 000 5〕of A group were statistically significantly shorter than those of B group,while LVEF of A group was statistically significantly higher than that of B group〔 RR = 4. 96,95% CI(4. 25,5. 66),P ﹤ 0. 000 01〕. Conclusion The clinical effect and safety of metoprolol succinate sustained - release tablets are significantly better than metoprolol tartrate tablets in treating chronic heart failure,has advantageous performance in improving the cardiac function.