咪达普利治疗急性心肌梗死对左心功能影响的荟萃分析

Ameta-analysis of the effects of mida prilonlef the artfunction in the treatment of acutemyocardial infarction

目的:综合评价咪达普利对急性心肌梗死患者左心功能的影响,为临床药物选择提供循证证据。方法:利用中国知网(CNKI)、万方数据库(Wanfang)、维普数据库(VIP)、PubMed、EMbase(各数据库检索时间均为从创建至2022年3月)全面检索咪达普利治疗急性心肌梗死的随机对照试验,按照纳排标准筛选、提取纳入文献的数据,并进行方法学质量评价。采用ACE活性、左室射血分数(LVEF)、左室舒张末期容积指数(EDVI)、左室收缩末期容积指数(ESVI)等左心室功能指标系统评估咪达普利治疗急性心肌梗死的有效性,并用RevMan 5.3软件进行统计分析(绘制森林图)。结果:共纳入5篇文献,分为试验组(咪达普利组)和对照组;与对照组相比,咪达普利组能更有效地降低ACE活性(SMD=-5.65;95%CI:-6.76,-4.55;P<0.00001);在降低ESVI方面,差异不显著(P=0.09);但在提升LVEF和降低EDVI方面,咪达普利组更显著,具有统计学差异(SMD=2.32;95%CI:0.70,3.93;P=0.005;SMD=-0.78;95%CI:-1.13,-0.43;P<0.0001)。结论:在常规治疗基础上联用咪达普利治疗急性心肌梗死,能更有效地降低患者体内ACE的活性,提升其LVEF,降低其EDVI,改善其左心室功能,值得临床推广。

Objective:To comprehensively evaluate the effects of midapril on left heart function in patients with acute myocardial infarction,and to provide evidence-based evidence for clinical drug selection.How:China National Knowledge Network(CNKI),Wanfang database,VIP database,PubMed and EMbase were used to comprehensively search the randomized controlled trials of midapril in the treatment of acute myocardial infarction(AMI),and the data of the included literatures were screened and extracted according to the sodium exclusion criteria.The quality of methodology was evaluated.ACE activity,left ventricular ejection fraction(LVEF),left ventricular end-diastolic volume index(EDVI),left ventricular end-systolic volume index(ESVI)and other left ventricular function indicators were used to evaluate the effectiveness of midapril in the treatment of acute myocardial infarction,and statistical analysis was performed with RevMan 5.3 software(forest map drawing).Results:A total of 5 literatures were included,which were divided into experimental group(midapril group)and control group.Compared with the control group,the midapril group was more effective in reducing ACE activity(SMD=-5.65;95%CI:-6.76,-4.55;P<0.00001);There was no significant difference in reducing ESVI(P=0.09).However,in terms of increasing LVEF and decreasing EDVI,the midapril group was more significant,with statistical difference(SMD=2.32;95%CI:0.70,3.93;P=0.005;SMD=-0.78;95%CI:-1.13,-0.43;P<0.0001).Conclusion:The combination of midapril with conventional therapy in the treatment of acute myocardial infarction can more effectively reduce the activity of ACE,increase LVEF,decrease EDVI and improve left ventricular function,which is worthy of clinical promotion.