美托洛尔与比索洛尔对慢性心力衰竭疗效比较的Meta分析
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摘要
目的比较美托洛尔和比索洛尔治疗慢性心力衰竭的疗效。方法计算机检索Embase、PubMed、Cochrane、MEDLINE、ClinicalTrials、万方数据库、中国知网、维普数据库,查找自从建库至2018年4月1日期间公开发表的比较美托洛尔和比索洛尔治疗慢性心力衰竭的随机对照试验。按纳入和排除标准进行筛选、资料提取和质量评价后,采用RevMan 5.3软件进行Meta分析。结果研究共纳入13项,患者1 487例。Meta分析结果显示:与美托洛尔相比,比索洛尔对慢性心力衰竭患者临床疗效、提高左心室射血分数、降低收缩压、舒张压和降心率改善的差异有统计学意义(P<0.05～0.001)。而两药对不良反应发生的差异无统计学意义(P>0.05)。结论比索洛尔药物能有效稳定病患的血压、心率和左室射血分数指标水平、提高临床疗效。由于纳入研究数目和质量有限,建议临床医生根据临床经验判断使用。
Objective To compare the efficacy of metoprolol and bisoprolol in the treatment of chronic heart failure.Methods Embase, PubMed, Cochrane, MEDLINE, ClinicalTrials, Wanfangdata, CNKI, and VIP database were retrieved to search for randomized controlled trials to compare the efficacy of metoprolol and bisoprolol in the treatment of chronic heart failure that have been published since the establishment of the database until April 1, 2018. After screening, data extraction,and quality assessment according to inclusion and exclusion criteria, meta-analysis was performed using RevMan 5.3 software. Results A total of 13 studies and 1 487 patients were included in this study. Meta-analysis showed that there was a statistically significant difference in clinical efficacy, improvement of left ventricular ejection fraction, decrease in systolic blood pressure and diastolic blood pressure and drop of heart rate between bisoprolol and metoprolol in the treatment of chronic heart failure(P<0.05, 0.001). There was no statistical difference in adverse reactions between the two drugs(P>0.05).Conclusion Bisoprolol is effective in stabilizing the blood pressure, heart rate and left ventricular ejection fraction and improving clinical outcomes. Due to the limited number and quality of included studies, clinicians are advised to use them based on clinical experience.
Objective To compare the efficacy of metoprolol and bisoprolol in the treatment of chronic heart failure.Methods Embase, PubMed, Cochrane, MEDLINE, ClinicalTrials, Wanfangdata, CNKI, and VIP database were retrieved to search for randomized controlled trials to compare the efficacy of metoprolol and bisoprolol in the treatment of chronic heart failure that have been published since the establishment of the database until April 1, 2018. After screening, data extraction,and quality assessment according to inclusion and exclusion criteria, meta-analysis was performed using RevMan 5.3 software. Results A total of 13 studies and 1 487 patients were included in this study. Meta-analysis showed that there was a statistically significant difference in clinical efficacy, improvement of left ventricular ejection fraction, decrease in systolic blood pressure and diastolic blood pressure and drop of heart rate between bisoprolol and metoprolol in the treatment of chronic heart failure(P<0.05, 0.001). There was no statistical difference in adverse reactions between the two drugs(P>0.05).Conclusion Bisoprolol is effective in stabilizing the blood pressure, heart rate and left ventricular ejection fraction and improving clinical outcomes. Due to the limited number and quality of included studies, clinicians are advised to use them based on clinical experience.
引文
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[12]孟辉,王宇平.比索洛尔和美托洛尔对慢性心力衰竭患者心脏功能及血浆脑钠肽水平的影响[J].医学综述,2016(12):2492-2495.
[13]郭宏新.比索洛尔和美托洛尔治疗慢性心力衰竭的效果对照分析与研究[J].中国现代药物应用,2018(3):80-81.
[14]高艳珍,刘向臣.比索洛尔与美托洛尔治疗慢性心力衰竭的临床疗效对比[J].中国继续医学教育,2017(1):175-176.
[15]唐练亭.比索洛尔与美托洛尔治疗慢性心力衰竭的临床疗效对比[J].中西医结合心血管病电子杂志,2017(13):7-8.
[16]钟伟.比索洛尔治疗慢性心力衰竭的临床观察[J].青海医药杂志,2004(5):35-36.
[17]贺范龙,冯君,杨海见.不同β受体阻滞剂对慢性心力衰竭患者心脏功能、血浆BNP及细胞因子水平的影响[J].健康研究,2016(1):104-105.
[18]丁宇慧,马志强,朱启明,等.两种β受体阻滞剂治疗慢性心衰的临床疗效及球结膜微循环观察[J].微循环学杂志,2007(3):50-52.
[19]邹晓荣,曹琴春.美托洛尔和比索洛尔治疗慢性心力衰竭患者120例的疗效观察[J].中国当代医药,2012(14):55-57.
[20]黄榆珍.美托洛尔缓释片和比索洛尔治疗慢性心力衰竭疗效比较[J].基层医学论坛,2011(2):12-13.
[21]徐小燕,吴军.美托洛尔联合比索洛尔治疗慢性心力衰竭的疗效比较[J].中国初级卫生保健,2012(2):97-98.
[22]赵晓慧.美托洛尔在慢性心力衰竭治疗中的应用体会[J].中国卫生标准管理,2016(9):100-101.
[23]李飞,卢熙奎.用富马酸比索洛尔片和酒石酸美托洛尔片治疗慢性心力衰竭的效果观察[J].当代医药论丛,2016(13):25-26.
[2]GARG R G,YUSUF S.Overview of randomised trials of angiotensinconverting enzyme inhibitors on mortality and morbidity in patients with heart failure[J].JAMA,1995,273(18):1450-1456.
[3]The SOLVD Investigators.Effect of enalapril on survival in patients with reduced left ventricular ejections fraction and congestive heart failure[J].N Engl J Med,1991,325(5):293-302.
[4]PFEFFER M A,BRAUNWALD E,MOYéL A,et al.Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction:results of the survival and ventricular enlargement trial[J].N Engl JMed,1992,327(10):669-677.
[5]WAAGSTEIN F,HJALMARSON?,VARNAUSKAS E,et al.Effect of chronic beta-adrenergic receptor blockade in congestive cardiomyopathy[J].Br Heart J,1975,37(10):1022-1036.
[6]SWEDBERG K,HJALMARSON?,WAAGSTEIN F,et al.Prolongation of survival in congestive cardiomyopathy byreceptor blockade[J].Lancet,1979,i:1374-1376.
[7]MERIT-HF Study Group.Effect of metoprolol CR/XL in chronic heart failure:Metoprolol CR/XL randomised intervention trial in congestive heart failure(MERIT-HF)[J].Lancet,1999,353(9169):2001-2007.
[8]LECHAT P,BRUNHUBER K W,HOFMANN R.The cardiac insufficiency bisoprolol study II(CIBIS-II):a randomised trial[J].Lancet,1999,353(9146):9-13.
[9]The Cochrane Collaboration.Cochrane handbook for systematic reviews of interventions 5.1.0[EB/OL].http://www.cochranelibrary.com/.(2011-03-12)[2014-03-27].
[10]杜晓明,孙浩,刘立民,等.替米沙坦治疗心力衰竭有效性与安全性的Meta分析[J].中国医院药学杂志,2011,31(24):2067-2069.
[11]赵彩霞,牛彩娟,牛剑武.比索洛尔对慢性心力衰竭的临床价值分析[J].中西医结合心血管病电子杂志,2016(6):43-44.
[12]孟辉,王宇平.比索洛尔和美托洛尔对慢性心力衰竭患者心脏功能及血浆脑钠肽水平的影响[J].医学综述,2016(12):2492-2495.
[13]郭宏新.比索洛尔和美托洛尔治疗慢性心力衰竭的效果对照分析与研究[J].中国现代药物应用,2018(3):80-81.
[14]高艳珍,刘向臣.比索洛尔与美托洛尔治疗慢性心力衰竭的临床疗效对比[J].中国继续医学教育,2017(1):175-176.
[15]唐练亭.比索洛尔与美托洛尔治疗慢性心力衰竭的临床疗效对比[J].中西医结合心血管病电子杂志,2017(13):7-8.
[16]钟伟.比索洛尔治疗慢性心力衰竭的临床观察[J].青海医药杂志,2004(5):35-36.
[17]贺范龙,冯君,杨海见.不同β受体阻滞剂对慢性心力衰竭患者心脏功能、血浆BNP及细胞因子水平的影响[J].健康研究,2016(1):104-105.
[18]丁宇慧,马志强,朱启明,等.两种β受体阻滞剂治疗慢性心衰的临床疗效及球结膜微循环观察[J].微循环学杂志,2007(3):50-52.
[19]邹晓荣,曹琴春.美托洛尔和比索洛尔治疗慢性心力衰竭患者120例的疗效观察[J].中国当代医药,2012(14):55-57.
[20]黄榆珍.美托洛尔缓释片和比索洛尔治疗慢性心力衰竭疗效比较[J].基层医学论坛,2011(2):12-13.
[21]徐小燕,吴军.美托洛尔联合比索洛尔治疗慢性心力衰竭的疗效比较[J].中国初级卫生保健,2012(2):97-98.
[22]赵晓慧.美托洛尔在慢性心力衰竭治疗中的应用体会[J].中国卫生标准管理,2016(9):100-101.
[23]李飞,卢熙奎.用富马酸比索洛尔片和酒石酸美托洛尔片治疗慢性心力衰竭的效果观察[J].当代医药论丛,2016(13):25-26.
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