曲美他嗪对慢性心力衰竭患者心率变异性影响的meta分析

Trimetazidine on Heart Rate Variability in Patients with Chronic Heart Failure: a meta-analysis

目的客观评价曲美他嗪(Trimetazidine,TMZ)对慢性心力衰竭(chronic heart failure,CHF)患者心率变异性(heart rate variability,HRV)的改善效果。方法计算机并手工检索2005年1月—2013年12月Cochrane图书馆临床对照试验库、Pub Med、EMbase、万方数据库、中国知网(CNKI)、中国生物医学文献数据库(CBM)、维普数据库收录的关于TMZ对CHF患者HRV影响的随机对照试验(RCT)研究文献,应用Rev Man 5.0软件对数据进行meta分析。结果本研究共纳入RCT文献10篇CHF共991例,其中常规联合TMZ治疗500例(试验组),单纯常规治疗491例(对照组),文献质量均为中等。meta分析结果显示,与对照组比较,试验组治疗后左室射血分数(LVEF)明显增加,差异有统计学意义(P<0.00001);HRV指标中,试验组治疗后正常R-R间期标准差(SDNN)、5 min正常R-R间期均值标准差(SDANN)、连续5 min R-R间期差值均方根(r MSSD)、R-R间期差值大于50 ms的百分比(PNN50)均明显增加或升高,与对照组比较差异均有统计学意义(P均<0.00001)。上述各指标漏斗图基本对称,存在发表偏倚可能性小。结论 TMZ联合常规抗心衰治疗CHF效果确切,可显著提高LVEF、HRV,改善患者预后。

Objective To evaluate the efficacy of the improvement with trimetazidine on heart rate variability （ HRV） in patients with chronic heart failure （ CHF） . Methods The related Randomized Controlled Trial literature of TMZ influence on HRV in patients with CHF were searched by computer from Cochrane Central Register of Controlled Trials databases, PubMed, EMbase, WanFangDATA, Chinese academic journal full-text detabase （ CNKI） , Chinese Biomedical Literature Da-tabase （CBM）, VIP database （VIP） and by hand during January 2005 and December 2013. All the data were processed by Meta-analysis using RevMan 5. 0. Results A total of 10 literatures, 991 patients ,including experimental group （convention-al therapy combined trimetazidine）：500 cases and control group （ conventional treatment）：491 cases, Literatures were medi-um quality. Meta-analysis showed that compared with the control group, left ventricular ejection fraction （ LVEF） in the ex-perimental group was obviously increased after therapy, and differences were statistically significant （P〈0. 00001）; In the indicators of HRV, standard deviation of all normal-to-normal intervals （ SDNN） , standard deviation of mean of all normalto-normal intervals in all consecutive 5-min segments of the entire recording （ SDANN） , root mean square of differences between adjacent normal-to-normal intervals （ rMSSD ） , the percentage of R-R intervals with more than 50 milliseconds variation （PNN50） were obviously increased or raised and all differences were statistically significant （P〈0. 00001）. There was little publication bias possibility in Meta-analysis a result from each symmetrical funnel schemas of above-mentioned indicators. Conclusion Existing evidence suggests that Trimetazidine combined therapy to patients with CHF has a curative effect, which can significantly improve LVEF, HRV, and can further improve the prognosis of patients with CHF.