美托洛尔治疗中国老年慢性心力衰竭患者的Meta分析

摘要

目的 评价美托洛尔治疗中国老年慢性心力衰竭的有效性及安全性.方法 计算机检索1989年至2012年7月Cochrane图书馆临床对照试验资料库(CCRCT)、Pubmed 、Embase、万方数据库、中国学术期刊全文数据库(CNKI)、维普数据库(VIP),收集美托洛尔治疗老年心力衰竭的随机对照试验(RCT),按纳入和排除标准由2名评价者独立选择试验、提取资料,交叉核对并进行方法学质量评估,使用RevMan 5.0软件进行Meta分析.结果 共纳入9项研究,760例患者.结果 显示,常规治疗基础上联用美托洛尔治疗老年慢性心力衰竭显著优于常规治疗对照组(RR=1.23,95%CI:1.15～1.32,P＜0.001);联用美托洛尔可降低左室舒张末期内径(LVEDD)(WMD=-5.94,95%CI:-6.83～-5.03,P＜0.001);增加左室射血分数(LVEF)(WMD=5.81,95%CI:4.86～6.76,P＜0.001);但同时造成不良反应发生率增加(RR=10.17,95%CI:3.92～26.37,P＜0.001),主要包括胸闷、乏力、头晕、双下肢水肿、心动过缓、房室传导阻滞等.结论 现有证据显示联合美托洛尔治疗可改善老年慢性心力衰竭临床疗效及心功能指标,但会使不良反应增加,应采取个体化治疗.受纳入文献质量的限制,美托洛尔治疗老年心力衰竭的疗效和安全性期待更多高质量的随机对照双盲研究,以做进一步的评价.%Objective To review the effectiveness and safety of metoprolol in the treatment of senile chronic heart failure ( CHF ) in China. Methods The databases of Cochrane Controlled Trials Register ( CCTR ) , PubMed, Embase, WanFang Database, China National Network Knowledge Infrastructure ( CNKI ) and VIP Database were retrieved with computer for collecting randomized controlled trials ( RCT ) about the treatment of senile CHF with metoprolol from 1989 to July, 2012. All data was selected, extracted, cross—checked and given methodological quality evaluation by two independent reviewers according to inclusion and exclusion criterions, and then a Meta—analysis was conducted by using RevMan 5.0. Results There were totally 9 RCT included involving 760 patients. The results showed that the curative effect on senile CHF was significantly better in group combining routine therapy and metoprolol ( combining group ) than that in control group ( RR=1.23, 95%CI: 1.15-1.32, P<0.001 ) . In combining group, LVEDD decreased ( WMD=-5.94, 95%CI: -6.83—5.03, P<0.001 ) , LVEF increased ( WMD=5.81, 95%CI: 4.86-6.76, P<0.001 ) , but at the same time, the incidence of adverse reactions increased (RR=WA1, 95%CI: 3.92-26.37, P<0.001 ) including chest stuffiness, fatigue, dizziness, double leg edema, bradycardia and atrioventricular block. Conclusion The existing evidences indicate that metoprolol can improve the curative effect and cardiac functional indexes, but increase adverse reactions in the treatment of senile CHF, so individualized treatment should be taken. The study is limited by the quality of included literature, and the curative effect and safety of metoprolol should be reviewed further by more RCT with higher quality.