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目的系统评价硝酸酯在慢性心力衰竭治疗中的疗效及安全性。方法计算机检索Pub Med、EMbase、Web of Science、The Cochrane Library(2016年1期)、CBM、CNKI、VIP和Wan Fang Data,检索时限均为从建库至2016年1月4日。由2位评价员按纳入与排除标准独立筛选文献、提取资料并评价偏倚风险后,采用Rev Man 5.3软件进行Meta分析。结果共纳入10个随机试验,共414例患者,其中硝酸酯组195例,对照组219例。Meta分析结果显示,与对照组相比,硝酸酯组能降低动脉血压[MD=–1.91,95%CI(–3.66,–0.16),P=0.03]和肺血管楔压[MD=–2.00,95%CI(–3.84,–0.15),P=0.03],能增加心脏指数[MD=0.25,95%CI(0.09,0.42),P=0.003]、平板运动时间[MD=70.14,95%CI(55.22,85.05),P<0.000 01],但更易出现副作用[OR=5.21,95%CI(2.60,10.41),P<0.000 01],两组差异均有统计学意义。结论目前临床证据显示,在常规治疗基础上,采用硝酸酯类能显著改善慢性心力衰竭患者的血液动力学效应,增加心排量,提高运动耐量。
Objective To systematically evaluate the efficacy and safety of nitrates in the treatment of chronic heart failure. Methods Pub Med, EMbase, Web of Science, The Cochrane Library (2016 issue 1), CBM, CNKI, VIP and Wan Fang Data were searched by computer. The search time ranged from database building to January 4, 2016. Two reviewers independently screened the literature by inclusion and exclusion criteria, extracted data, and assessed the risk of bias. Meta-analysis was performed using Rev Man 5.3 software. Results A total of 10 randomized trials were included, 414 patients were included, of which 195 were in the nitrate group and 219 in the control group. Meta-analysis showed that nitrates reduced arterial blood pressure (MD = -1.91,95% CI -3.66, -0.16, P = 0.03) and pulmonary vascular wedge pressure (MD = -2.00, 95% CI (0.09, 0.42), P = 0.003], treadmill exercise time [MD = 70.14, 95% CI (55.22, 85.05), P <0.000 01], but more likely to have side effects [OR = 5.21,95% CI (2.60,10.41), P <0.000 01], with significant differences between the two groups. Conclusions The current clinical evidence shows that nitrates can significantly improve hemodynamics, increase cardiac output and improve exercise tolerance in patients with chronic heart failure.