卡维地洛对扩张型心肌病疗效的荟萃分析

Efficacy of carvedilol in treatment of dilated cardiomyopathy:a meta analysis

目的评价卡维地洛治疗扩张型心肌病的疗效。方法检索PubMed、the Cochrane Central Register of Controlled Trials(CENTRAL)、ClinicalTrials.gov(https://clinicaltrials.gov/)、WanFang Data、CNKI、CBM和VIP数据库,收集2016年10月之前卡维地洛治疗扩张型心肌病的随机对照试验。采用RevMan 5.3软件进行荟萃分析。结果共纳入9项研究810例患者。荟萃分析显示:卡维地洛组左心室射血分数(MD=8.03,95%CI=6.47~9.58,P<0.01)高于安慰剂组,其心率(MD=-9.21,95%CI=-17.45^-0.97,P=0.03)、左心室舒张末内径(MD=-7.11,95%CI=-11.81^-2.40,P<0.003]和死亡率(OR=0.33,95%CI=0.15~0.76,P<0.01)均低于安慰剂组,两组收缩压(MD=-7.88,95%CI=-18.61~2.85,P=0.15)和舒张压(MD=-1.15,95%CI=-5.48~3.17,P=0.60)差异无统计学意义。结论对于扩张型心肌病患者,卡维地洛可以提高左心室射血分数,减小左心室舒张末内径,改善心功能,并能减慢心率,降低死亡率,对血压无明显影响,而其对死亡率的影响尚需进一步研究。

Objective To evaluate the efficacy of carvedilol in treatment of dilated cardiomyopathy.Methods The PubMed,the Cochrane Central Register of Controlled Trials(CENTRAL),Clinical Trials.gov(https://clinicaltrials.gov/),WanFang Data,CNKI,CBM and VIP database were retrieved to collect randomized controlled trials of carvedilol in the treatment of dilated cardiomyopathy before October 2016.RevMan5.3 software was used to analyze the data.Results A total of 810 patients(9 randomized controlled trials)were included.In the meta-analysis,the left ventricular ejection fraction(MD=8.03,95%CI=6.47-9.58,P<0.01)was significantly higher in the carvedilol group compared to placebo group,the heart rate(MD=-9.21,95%CI=-11.81--2.40,P<0.003),left ventricular end diastolic diameter(MD=-7.11,95%CI=-11.81--2.40,P<0.003)and mortality(OR=0.33,95%CI=-18.61-2.85,P=0.15)were significantly lower in the carvedilol group compared to placebo group,systolic blood pressure(MD=-7.88,95%CI=-18.61-2.85,P=0.15,and diastolic blood pressure(MD=-1.15,95%CI=-5.48-3.17,P=0.60)were similar between the carvedilol group and placebo group.Conclusion In patients with dilated cardiomyopathy,carvedilol can improve left ventricular ejection fraction,decrease left ventricular end diastolic diameter and improve heart function furthermore.Meanwhile carvedilol can slow down heart rate and reduce mortality,while blood pressure was not significantly affected.However,its impact on mortality still needs further study.