伊伐布雷定治疗慢性心力衰竭临床疗效Meta分析

Meta-analysis for Clinical Efficacy of Ivabradine Treating the Patients With Chronic Heart Failure

目的:系统评价伊伐布雷定治疗慢性心力衰竭的临床疗效。方法:计算机检索Pub Med,Conchrane Library,EMbase,中国生物医学数据库(CBM),中国知网(CNKI),万方数据库,检索日期从建库至2016-10。纳入伊伐布雷定治疗慢性心力衰竭的随机对照研究,并采用Revman 5.2软件进行Meta分析。结果:最终纳入12篇文献,均为英文文献,实验组807例,对照组800例。Meta分析显示:与对照组相比,实验组左心室射血分数较高(MD=2.68,95%CI:1.85~3.50,P<0.00001),左心室舒张末容积(MD=-5.78,95%CI:-9.79^-1.76,P=0.005)和左心室收缩末容积降低(MD=-8.91,95%CI:-11.23^-6.59,P<0.00001);实验组收缩压(MD=6.02,95%CI:-0.80~12.84,P=0.08)和舒张压(MD=3.64,95%CI:-0.48~7.77,P=0.08)与对照组相比差异均无统计学意义;实验组N末端B型利钠肽原(NT-pro BNP)与对照组相比显著降低(MD=-109.22,95%CI:-126.42^-92.01,P<0.00001)。结论:伊伐布雷定能改善慢性心力衰竭室重构,但对血压无明显影响。其长期疗效和安全性仍需高质量的随机对照研究及循证医学的证实。

Objective： To systemically evaluate clinical efficacy of ivabradine （IVA） treating the patients with chronic heart failure （CHF）. Methods： We searched PubMed, Conchrane Library, EMbase, CBM, CNKI and Wanfang database to enroll the random control trials of IVA treating CHF up to 2016-10. Meta-analysis was performed by RevMan 5.2 software. Results： A total of 12 English literature were finally enrolled which including 2 groups： IVA group, n=807 and Control group, n=800. Meta-analysis showed that compared with Control group, IVA group had increased LVEF （MD=2.68, 95%CI 1.85-3.50, P〈0.00001）, decreased left ventricular end-diastolic volume （MD=-5.78, 95% CI -9.79 to -1.76, P=0.005）, decreased left ventricular end-systolic volume （MD=-8.91, 95% CI -11.23 to -6.59, P〈0.00001） and reduced N-terminal pro-brain natriuretic peptide （MD=-109.22, 95% CI -126.42 to -92.01, P〈0.00001）; while systolic blood pressure （MD=6.02, 95%CI -0.80 to 12.84, P=0.08） and diastolic blood pressure （MD=3.6495% CI -0.48 to 7.77, P=0.08） were similar between 2 groups. Conclusion： IVA improved ventricular remodeling in CHF patients and had no obvious effect on blood pressure. The long-term effect and safety of IVA should be further confirmed by high quality random control trial and the result from evidence-based medicine.