卡维地洛对比美托洛尔治疗慢性心力衰竭疗效和安全性的Meta分析

Therapeutic Efficacy and Safety of Carvedilol vs. Metoprolol in the Treatment of Chronic Heart Failure:a Meta-analysis

目的:系统评价卡维地洛对比美托洛尔治疗慢性心力衰竭的疗效和安全性,以为临床治疗提供循证参考。方法:计算机检索Pub Med、Cochrane图书馆、中国期刊全文数据库、维普数据库、万方数据库,全面收集卡维地洛(试验组)对比美托洛尔(对照组)治疗慢性心力衰竭的随机对照试验(RCT),对纳入研究进行质量评价和资料提取后,采用Rev Man 5.2统计软件进行Meta分析。结果:共纳入10项RCT,包括680例患者。Meta分析结果显示,试验组患者心功能改善有效率[OR=0.44,95%CI(0.24,0.81),P=0.008]、左心室射血分数[MD=-4.62,95%CI(-6.41,-2.82),P<0.000]、心率[MD=5.56,95%CI(2.69,8.42),P<0.000]、收缩压[MD=6.18,95%CI(4.42,7.94),P<0.000]、血浆脑钠肽[MD=366.23,95%CI(182.14,550.32),P<0.000]及头昏乏力发生率[OR=0.11,95%CI(0.01,0.92),P=0.04]显著优于对照组;两组患者左心室舒张末期内径[MD=1.41,95%CI(-1.82,4.64),P=0.39]、舒张压[MD=2.66,95%CI(-0.15,5.48),P=0.06]、6 min步行距离[MD=11.89,95%CI(-70.04,93.81),P=0.78]及其他不良反应发生率等比较,差异均无统计学意义。结论:卡维地洛治疗慢性心力衰竭疗效优于美托洛尔,安全性相当。由于纳入研究数量和质量有限,该结论仍需进行更多设计、执行和报道均良好的高质量RCT进一步验证。

OBJECTIVE： To evaluate therapeutic efficacy and safety of carvedilol vs. metoprolol in the treatment of chronic heart failure systematically, and to provide evidence-based reference for clinical treatment. METHODS： Retrieved from PubMed, Cochrane Library, CNKI, VIP Database and Wanfang Database, randomized controlled trials （RCT） about carvedilol （trial group） vs. metoprolol （control group） in the treatment of chronic heart failure were collected, and Meta-analysis was conducted by using Rev Man 5.2 statistical software after evaluating the quality of included studies and extracting the data. RESULTS： A total of 10 RCT were included, involving 680 patients. Meta-analysis showed the effective rate of heart function improvement [OR= 0.44,95 % CI（0.24,0.81）,P=0.008], LVEF[MD=--4.62, 95%CI（--6.42,--2.82）,P〈0.000], heart rate [MD=5.56, 95%CI（2.69, 8.42）, P〈0.000], SBP [MD=6.18, 95% CI （4.42, 7.94） , P〈0.000], plasma brain natriuretic peptide [MD=366.23, 95% CI （182.14, 550.32）, P〈 0.000] and the incidence of dizziness anaemic [OR = 0.11,95 % CI （0.01,0.92）, P= 0.04] in trial group were significant- ly better than in control group; the LVDD [MD = 1.41, 95 % CI （ -- 1.82,4.64）, P= 0.39], DBP [MD---- 2.66,95 % CI （ -- 0.15,5.48 ）, P = 0.06], 6 min walk test [MD = t 1.89,95 % CI （ -- 70.04,93.81 ）, P= 0.78], the incidence of other ADR showed no statistically sig- nificant difference in 2 groups. CONCLUSIONS： Therapeutic efficacy of carvedilol is better than metoprolol in the treatment of chronic heart failure, but both have similar safety. Due to the limits of number and quality, more high-quality and large-scale long-term RCTs are required for further validation of the conclusion.