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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 evaluate the efficacy and safety of single-agent and combination therapy of calcium channel blockers (CCBs) and angiotensin-converting enzyme inhibitors (ACEIs) on left ventricular hypertrophy (LVH) in Chinese patients with hypertension. Methods The Cochrane Central Register of Controlled Trials Database was searched by computer (PubMed, 1980-2011), EMbase (1990-2011), CBM (1978-2011), CNKI (1994-2011) 2011) and WanFang Data (1998 ~ 2011). According to the inclusion and exclusion criteria, after selecting the literature and evaluating the quality, RevMan5.1 software was used for meta-analysis. Results A total of 10 randomized controlled trials (RCTs) were included in the study, 859 patients. The results of Meta analysis showed that systolic blood pressure (MD) was significantly lower in patients with EH (MD = -6.49, 95% CI -10.55, -2.43), diastolic blood pressure [MD = -4.48, 95% CI -6.76, -2.21)], LVMI [MD = -5.31,95% CI (-8.43, -2.19)], end diastolic interventricular septum thickness (IVST) [MD = -1.33,95% C -2.00, -0.66) and left ventricular posterior wall thickness (LVPWT) [MD = -0.87,95% C (I-1.41, -0.33)] were superior to the CCBs alone group. In addition, the combination group was significantly less effective in reducing LVMI [MD = -11.54,95% CI (-15.06, -8.01)], IVST [MD = -0.76,95% CI -1.25, -0.27 )] And LVPWT [MD = -0.80,95% CI (-1.01, -0.59)]. However, in terms of the indexes of left ventricular end diastolic diameter, shortening of left ventricular short axis and left ventricular ejection fraction In terms of improvement, the clinical effects of combination group and CCBs alone or ACEIs group were similar (P> 0.05). Conclusion Combination of CCBs and ACEIs is better than single CCBs or ACEIs in reversing left ventricular hypertrophy. Due to the poor methodology of the included studies and the small sample size, the above conclusion remains to be confirmed by more high-quality, large sample, multicenter RCTs.