摘要:
Objective To systematically evaluate the effectiveness and safety of different calcium channel blockers (CCBs) in preventing stroke in hypertensive patients.Methods PubMed,Cochrane Library,Embase,Wanfang,CNKI,CBM,and other databases were comprehensively retrieved,and the randomized controlled trials of different CCBs in the prevention of stroke in hypertensive patients were collected.The retrieval time was from the establishment of the databases to November 5,2018.The languages were limited to Chinese and English.The literature screening,study inclusion,information extraction,and quality evaluation were independently conducted by two professional reviewers.A network diagram was drawn using Stata 13.0,and a meta-analysis of the included studies was performed using the Bayes model of the GeMTC 1.4.3 software.Results A total of 12 studies with 58 468 patients were enrolled.Network metaanalysis showed that nitrendipine (odds ratio 0.63,95% confidence interval 0.44-0.89) and nifedipine (odds ratio 0.68,95% confidence interval 0.46-0.92) were statistically significant in reducing the incidence of stroke.Other CCBs were not statistically significant in reducing the incidence of stroke,but had clinical differences.For the effectiveness of applying different CCBs to reduce the incidence of stroke,lacidipine should be preferred,followed by amlodipine,nitrendipine,nifedipine,and felodipine.However,there were no statistically significant differences in the effectiveness of different CCBs in preventing stroke.Conclusion Different CCBs can effectively reduce the incidence of stroke.In terms of specific drug types,lacidipine should be considered first,followed by amlodipine,nitrendipine,nifedipine,and felodipine.%目的 系统评价不同钙通道阻滞药(calcium channel blockers,CCBs)预防高血压患者卒中的有效性和安全性.方法 通过计算机全面检索PubMed、Cochrane Library、Embase、万方、CNKI、CBM等数据库,收集不同CCBs类药物预防高血压患者卒中发病的随机对照试验,检索时间均从建库至2018年11月5日,语言限定为中文和英文.由2名专业评价员独立进行文献筛选、纳入研究、信息提取及质量评价,应用Stata 13.0绘制网络图,应用GeMTC 1.4.3软件的贝叶斯模型对纳入研究进行网络meta分析.结果 最终纳入12项研究,共58 468例患者.网络meta分析显示,与安慰剂相比,尼群地平(优势比0.63,95%可信区间0.44~0.89)和硝苯地平(优势比0.68,95%可信区间0.46~0.92)在降低卒中发生率方面具有统计学意义,其他CCBs在降低卒中发生率方面虽不具有统计学意义,但具有临床差异.在应用不同CCBs降低卒中发病的有效性方面,应首选拉西地平,其余依次为氨氯地平、尼群地平、硝苯地平和非洛地平,但不同CCBs在预防卒中发病的有效性方面差异并无统计学意义.结论 不同CCBs均可有效降低卒中发生率.在具体药物种类方面,应首先考虑拉西地平,其余依次为氨氯地平、尼群地平、硝苯地平和非洛地平.