醋柳黄酮治疗原发性高血压的系统评价

Total Flavones of Hippophae Rhamnoides L. for Essential Hypertension:A Systematic Review of Randomized Controlled Trials

目的系统评价醋柳黄酮(TFH)治疗原发性高血压的有效性、安全性和成本效果。方法计算机检索Cochrane图书馆临床对照试验资料库(2009年第2期)、MEDLINE(1950～2009.6)、EMbase(1980～2009.6)、中国期刊全文数据库(1995～2009.6)、中国科技期刊全文数据库(1989～2009.6),手工检索相关会议论文集及药厂资料等。按照纳入和排除标准选择试验、评价质量和提取资料,并用RevMan5.0软件对数据进行Meta分析。结果共纳入7个随机对照试验(RCT),包括644例患者,其中5个RCT方法学质量评价为B级,2个为C级。Meta分析结果显示:醋柳黄酮单药应用在降低舒张压方面与钙通道阻滞剂(CCB)[WMD=2.34,95%CI(–0.86,5.53)]和血管紧张素转换酶抑制剂(ACEI)[WMD=–0.01,95%CI(–0.97,0.95)]比较,差异均无统计学意义;醋柳黄酮在降低收缩压方面劣于ACEI类药物[WMD=3.95,95%CI(1.71,6.20)],但与CCB类药物的差异无统计学意义[WMD=2.62,95%CI(–2.02,7.26)];醋柳黄酮联合CCB在降低收缩压、舒张压、室间隔厚度、左心室后壁厚度方面优于单用CCB(均为P<0.00001);醋柳黄酮在降低室间隔厚度和左心室后壁厚度方面劣于ACEI(均为P<0.00001);醋柳黄酮在降低血β2微球蛋白[WMD=–0.57,95%CI(–1.18,0.04),P=0.07]、减少24小时尿蛋白(P=0.42)及改善内生肌酐排泄率(P=0.19)方面与ACEI组差异无统计学意义;醋柳黄酮的药物不良反应少于ACEI[RR=0.28,95%CI(0.13,0.60),P=0.001]和CCB(P=0.04);成本上每降低1mmHg收缩压和舒张压所需的费用低于ACEI。结论现有研究表明,醋柳黄酮能有效降低收缩压和舒张压,对心脏和肾脏有保护作用,不良反应较少,而且经济学效果较好。但由于纳入研究存在选择性偏倚和测量偏倚的可能性,势必影响结果的论证强度,期待更多高质量的随机双盲试验提供高质量的证据。

Objective To assess the efficacy, safety, and economy of Totalflavones ofHippophae Rhamnoides L. （TFH） for Essential Hypertension. Methods We searched the Cochrane Central Register of Controlled Trials （Issue 2, 2009）, MEDLINE （1950 to June 2009）, EMbase （1980 to June 2009）, CNKI （1995 to June 2009）, and VIP （1989 to June 2009）. We also handsearched the relevant journals and conference proceedings. Then we screened the retrieved studies according to predefined inclusion and exclusion criteria, evaluated the quality of the included studies, and performed meta-analyses using the Cochrane Collaboration RevMan 5.0 software. Results Only seven trials involving 644 patients were included. The results of meta-analyses showed that TFH had the similar effects to calcium-channel blocker （CCB） （WMD 2.34, 95%CI -0.86 to 5.53） and angiotensin-converting enzyme inhibitor （ACEI） （WMD -0.01, 95%CI -0.97 to 0.95） in decreasing diastolic blood pressure, but TFH plus CCB was superior to CCB in decreasing systolic blood pressure （P〈0.000 01） and diastolic blood pressure （P〈0.000 01）. TFH was inferior to ACEI in improving left ventricular posterior wall thickness （LVPWT） （P〈0.000 01） and inter ventricular septum thickness （IVST） （P〈0.000 01）, but TFH plus CCB was more effective in improving LVPWT （P〈0.000 01） and IVST （P〈0.000 01）. Moreover, TFH was similar to ACEI in regulating blood β2-microglobulin （WMD -0.57, 95%CI -1.18 to 0.04）, creatinine clearance rate （P=0. 19）, and urinary albumin value in 24 hours （P=0.42）. The incidence of adverse effects was significantly lower in the TFH group compared to the ACEI group. Conclusion The evidence available shows that TFH may decrease systolic and diastolic blood pressure. Moreover, TFH has fewer adverse effects and less economy load, and can protect the target organs. Due to a high risk of selection bias and detection bias in the included studies, the evidence is insufficient to determine the effect of TFH. Further large-scale trials are required to define the role of TFH in the treatment of essential hypertension.