曲美他嗪治疗缺血性心肌病效果的荟萃分析

Meta-analysis of efficacy of trimetazidine on treatment of ischemic cardiomyopathy

目的评估曲美他嗪治疗缺血性心肌病患者的疗效。方法在PubMed,EMBASE和Cochrane等数据库中进行系统性文献检索,检索时限为2015年3月以前,并在各纳入文献和相关综述的引文目录中寻找额外的合适的研究。采用固定或随机效应模型计算合并危险比(RR)和加权平均差(WMD)。结果共纳入13项随机对照试验共737例接受曲美他嗪或安慰剂治疗的缺血性心肌病患者。曲美他嗪可以明显改善左心室射血分数(WMD=6.98,95%CI:5.52~8.45,Z=9.35,P<0.001),6 min步行距离(WMD=83.39,95%CI:21.36~145.43,Z=2.63,P=0.008)和纽约心功能分级(NYHA)(WMD=4.28,95%CI:-0.95^-0.35,Z=4.28,P<0.001)。此外,曲美他嗪还显著降低左心室收缩末期内径(WMD=-6.14,95%CI:-7.55^-4.74,Z=8.57,P<0.001),左心室舒张末期内径(WMD=-5.23,95%CI:-6.04^-4.41,Z=12.57,P<0.001),左心室收缩末期容量(WMD=-13.22,95%CI:-21.89^-4.56,Z=2.99,P=0.003),左心室舒张末期容量(WMD=-11.36,95%CI:-14.22^-8.50,Z=7.79,P<0.001),室壁运动评分指数(WMD=-0.22,95%CI:-0.33^-0.11,Z=3.99,P<0.001),心血管事件和住院率(RR=0.35,95%CI:0.22~0.56,Z=1.74,P<0.001)。然而,在CRP水平和全因死亡率,曲美他嗪和安慰剂比较差异无统计学意义。结论在缺血性心肌病患者中,曲美他嗪可以有效改善临床症状和心功能,并且可以减少心脏原因的住院风险。

Objective To assess the treatment effect of trimetazidine （ TMZ ） in patients with ischemic cardiomyopathy . Methods An extensively systemic search of three computerized databases （PubMed,EMBASE and Cochrane databases ） was performed up to March 2015,and additional appropriate studies were searched in the citations of each included literature and related reviews .Pooled risk ratio （ RR） and weighted mean differences （ WMD） were calculated using fixed or random effects models. Results Thirteen randomized controlled trials （ RCTs） involving 737 ischemic cardiomyopathy patients treated with TMZ or placebo were included .TMZ therapy was significantly associated with improvement of left ventricular ejection fraction （WMD=6.98,95% CI：5.52 to 8.45,Z =9.35, P 〈0.001）,6 minute walk distance （WMD=83.39,95% CI：21.36 to 145.43, Z =2.63, P =0.008） and NYHA classification （ WMD = 〈br〉 4.28,95%CI：-0.95 to -0.35,Z=4.28,P〈0.001）.Moreover,TMZ treatment also markedly reduced left ventricular end-systolic diameter （WMD=-6.14,95%CI：-7.55 to -4.74,Z=8.57,P〈0.001）, left ventricular end-diastolic diameter （ WMD =-5.23, 95% CI： -6.04 to -4.41, Z =12.57, P 〈0.001）,left ventricular end-systolic volume （WMD=-13.22,95%CI：-21.89 to -4.56,Z=2.99,P=0.003）,left ventricular end-diastolic volume （WMD=-11.36,95%CI：-14.22 to -8.50,Z=7.79,P〈0.001）,wall motion score index （WMD=-0.22,95%CI：-0.33 to -0.11, Z=3.99,P〈0.001）,and cardiovascular events and hospitalization （ RR =0.35, 95% CI：0.22 to 0.56, Z =1.74, P 〈0.001）. However ,there was no significant difference in C-reactive protein levels and all-cause mortality between TMZ and control group. Conclusions In patients with ischemic cardiomyopathy ,TMZ treatment could effectively improve clinical symptoms and cardiac function ,and reduce the risk of hospitalization for cardiac causes .