曲美他嗪治疗微血管心绞痛疗效和安全性的系统评价

Systematic evaluation of efficacy and safety of trimetazidine in treatment of coronary microvascular angina

目的系统评价曲美他嗪治疗微血管心绞痛(CMVA)的临床疗效和安全性。方法检索中国学术期刊数据库(CNKI)、万方数据库(Wanfang)、中国生物医学文献服务系统(SinoMed)、维普中文期刊全文数据库(VIP)、PubMed和Web of Science(WOS)数据库从建库至2022年5月有关曲美他嗪治疗CMVA的临床随机对照试验(RCT),采用ReviewManager 5.3软件进行Meta分析。结果共纳入12项RCTs,包括1195例患者,其中试验组609例、对照组586例。Meta分析结果显示,与对照组比较,试验组的心绞痛症状临床疗效提高,心绞痛症状改善的总有效例数增加[OR=4.63,95%CI(3.20,6.72),P<0.00001]、显效例数增加[OR=1.94,95%CI(1.40,2.68),P<0.00001];平板运动试验总运动时间延长[MD=1.31,95%CI(1.02,1.60),P<0.00001],平板运动试验心电图ST段压低0.1 mV时间延长[MD=1.28,95%CI(0.98,1.59),P<0.00001],平板运动试验心电图ST段最大压低幅度降低[SMD=-1.19,95%CI(-1.72,-0.65),P<0.00001]。结论曲美他嗪可以改善CMVA患者心绞痛症状,延长CMVA患者平板运动时间和平板运动试验中心电图ST段压低0.1 mV所需时间、降低ST段压低的最大幅度。

Objective To systematically evaluate the clinical efficacy and safety of trimetazidine(TMZ)in the treatment of coronary microvascular angina(CMVA).Methods Data were electronically searched from the CNKI,Wanfang Data,SinoMed,VIP,PubMed and Web of Science to collet randomized controlled trails(RCTs)on TMZ in the treatment of CMVA.The retrieval time was from database establishment to May 2022.Meta-analysis was performed using ReviewManager 5.3 software.Results A total of 12 RCTs were included,including 1195 patients which 609 cases in experimental group and 586 cases in control group.Meta-analysis results showed that compared with the control group,the experimental group were increased the clinical efficacy of angina pectoris symptom,the total effective cases[OR=4.63,95%CI(3.20,6.72),P<0.00001],and the significant effective cases[OR=1.94,95%CI(1.40,2.68),P<0.00001],were prolonged the total exercise time of treadmill exercise test[MD=1.31,95%CI(1.02,1.60),P<0.00001]and the time of ST segment depression was prolonged by 0.1 mV in treadmill exercise test[MD=1.28,95%CI(0.98,1.59),P<0.00001],and decreased the maximal depression of ST segment in treadmill exercise test[SMD=-1.19,95%CI(-1.72,-0.65),P<0.00001].Conclusion TMZ can improve angina pectoris symptoms in CMVA patients,prolong treadmill exercise time and the time required for ST segment depression of 0.1 mV in treadmill exercise test,and reduce the maximum ST segment depression.