摘要
目的系统评价钙通道阻滞剂(CCBs)与血管紧张素转换酶抑制剂(ACEIs)单一用药与联合治疗对中国高血压(EH)患者左室肥厚(LVH)的疗效和安全性。方法计算机检索Cochrane图书馆临床对照试验数据库(2011年第7期)、PubMed(1980～2011)、EMbase(1990～2011)、CBM(1978～2011)、CNKI(1994～2011)、VIP(1989～2011)和WanFang Data(1998～2011),按照纳入与排除标准选择文献并评价质量后,采用RevMan5.1软件进行Meta分析。结果共纳入10个临床随机对照试验(RCT),859例患者。Meta分析结果显示:CCBs与ACEIs联合用药组在改善EH患者收缩压[MD=–6.49,95%CI(–10.55,–2.43)]、舒张压[MD=–4.48,95%CI(–6.76,–2.21)]、左室心肌重量指数(LVMI)[MD=–5.31,95%CI(–8.43,–2.19)]、舒张末室间隔厚度(IVST)[MD=–1.33,95%C(I–2.00,–0.66)]和左室后壁厚度(LVPWT)[MD=–0.87,95%C(I–1.41,–0.33)]方面均优于单用CCBs组。此外,与单用ACEIs组相比,联合用药组在降低LVMI[MD=–11.54,95%CI(–15.06,–8.01)]、IVST[MD=–0.76,95%CI(–1.25,–0.27)]及LVPWT[MD=–0.80,95%CI(–1.01,–0.59)]方面具有明显优越性;但在左室舒张末内径、左室短轴缩短率及左室射血分数等指标的改善方面,联合用药组与单用CCBs或ACEIs组的临床效果相当(P>0.05)。结论 CCBs与ACEIs联合用药组在逆转左室肥厚方面要优于单用CCBs或ACEIs组。由于所纳入研究的方法学质量较差,且样本量较少,上述结论有待开展更多高质量、大样本、多中心的RCT加以证实。
Objective To systematically evaluate the effectiveness and safety of calcium channel blockers（CCBs） and angiotensin-converting enzyme inhibitors（ACEIs） used alone v.s.used in combination on the reversion of left ventricular hypertrophy（LVH） in Chinese essential hypertension（EH） patients.Methods The following databases were searched,including,Cochrane Library（Issue 7,2011）,PubMed（1980 to 2011）,EMbase（1990 to 2011）,CBM（1978 to 2011）,CNKI（1994 to 2011）,VIP（1989 to 2011）,and WanFang Data（1998 to 2011）.The studies were screened,and the quality was evaluated according to predefined inclusion and exclusion criteria,and then Meta-analysis was conducted by using RevMan 5.1 software.Results A total of 10 studies involving 859 patients were included.The results of Meta-analysis showed that the CCBs plus ACEIs group（the combination group） was superior to the CCBs group in improving EH patients＇ systolic pressure（SBP）（MD= –6.49,95%CI –10.55 to –2.43）,diastolic pressure（DBP）（MD= –4.48,95%CI –6.76 to –2.21）,left ventricular mass index（LVMI）（MD= –5.31,95%CI –8.43 to –2.19）,interventricular septal thickness（IVST）（MD= –1.33,95%CI –2.00 to –0.66） and left ventricular posterior wall thickness（LVPWT）（MD= –0.87,95%CI –1.41 to –0.33）.In addition,compared with the ACEIs group,the combination group was greatly superior in decreasing LVMI（MD= –11.54,95%CI –15.06 to –8.01）,IVST（MD= –0.76,95%CI –1.25 to –0.27） and LVPWT（MD= –0.80,95%CI –1.01 to –0.59）.But clinical effectiveness was similar between the combination group and the CCBs group or the ACEIs group in aspects of the left ventricular end diastolic diameter（LVEDD）,fraction shortening（FS） and ejection fractions（EF）（P0.05）.Conclusion The combination therapy of CCBs with ACEIs is superior to either the CCBs or the ACEIs monothrepy in regression of left ventricular hypertrophy.Because of the low methodological quality and small sample,this conclusion needs to be proved by more high-quality,large-scale and multicenter randomized controlled trials in the future.
出处
《中国循证医学杂志》
CSCD
2012年第4期436-444,共9页
Chinese Journal of Evidence-based Medicine
基金
2010~2011年甘肃省重点中医药科研立项课题(编号:GZK-2010-Z1)
兰州大学第二医院重点基金(编号:YJ2010-02)
关键词
中国人群
高血压
左室肥厚
钙通道阻滞剂
血管紧张素转换酶抑制剂
系统评价
Chinese population
Hypertension
Left ventricular hypertrophy
Calcium channel blocker
Angiotensin-converting enzyme inhibitor
Meta-analysis
