依伐布雷定在冠状动脉CT检查中应用的Meta分析

Administration of ivabradine in computerized tomography(CT) of coronary artery: a Meta-analysis

目的采用Meta分析的方法评价依伐布雷定在冠状动脉CT检查中控制心率的效果。方法通过检索Pub Med、Cochrane Central Register of Controlled Trials、EMbase、CBM、CNKI、万方数据库,对符合条件随机对照研究经质量评估、数据提取,进行Meta分析。结果纳入8项随机对照研究。共计观察1298例,治疗组765例,对照组533例。结果显示,与对照组比较,依伐布雷定可以明显减慢心率(MD=-8.92,95%CI:-10.24^-7.59,P<0.0001);依伐布雷定减慢心率作用较β受体阻滞剂更为明显(MD=-5.16,95%CI:-8.54^-1.78,P=0.003);两种剂量(10 mg和15 mg)间减慢心率无明显区别(MD=4.87,95%CI:-5.81~15.55,P=0.37)。与对照比较,依伐布雷定轻度升高收缩压;与β受体阻滞剂比较可以轻度升高舒张压。依伐布雷定达到目标心率比率明显优于对照组(MD=3.78,95%CI:2.79~5.13,P<0.0001),与β受体阻滞剂比较无明显区别。不良反应为一过性窦性心动过缓、光幻觉、视力模糊、闪光感,无危及生命的严重不良反应。结论在冠状动脉CT检查中,依伐布雷定(10~15mg)可以替代β受体阻滞剂和(或)非二氢吡啶类钙离子拮抗剂用于的心率控制。

Objective To review the effect of ivabradine on heart rate （HR） controlling during computerized tomography （CT） of coronary artery by applying Meta-analysis. Methods The databases of PubMed, CENTRAL, EMbase, CBM, CNKI and WanFang Database were retrieved, and eligible randomized controlled trials （RCT） were given Meta-analysis after quality reviewing and data extracting. Results There were 8 RCT included involved 1298 cases, and 765 in intervention group and 533 in control group. The results showed that HR was significantly decreased in intervention group （MD=-8.92, 95%CI -10.24~ -7.59, P〈0.0001） compared with control group, and the effect of decreasing HR was more significant in intervention group than that in β-receptor blocker group （MD=-5.16, 95%CI： -8.54~ -1.78, P=0.003）. There was no significant difference between 10 mg ivabradine and 15 mg ivabradine in decreasing HR （MD=4.87, 95%CI： -5.81~15.55, P=0.37）. The systolic blood pressure was slightly elevated in intervention group compared with that in control group, and diastolic blood pressure was slightly elevated in intervention group compared with β-receptor blocker group. The percentage of achieving target HR was higher in intervention group than that in blank control group （MD=3.78, 95%CI： 2.79~5.13, P〈0.0001）, and the difference was not significant between intervention group and β-receptor blocker group. The adverse reactions were mainly transient nodal bradyarrhythmia, photopsy, blurred vision and photopsia. There were no severe life-threatening adverse reactions observed. Conclusion During CT of coronary artery, ivabradine （10 mg～15 mg） can be used to replace β-receptor blocker and/or non-dihydropyridines calcium channel blocker for controlling HR.