摘要
目的系统评价尼可地尔治疗微血管性心绞痛的临床效果及其对血管内皮功能的影响。方法计算机检索中国知网(CNKI)、重庆维普(VIP)数据库、万方数据库、PubMed、the Cochrane Library、EMbase公开发表的随机/半随机对照研究,检索时限为建库至2019年10月,由两名研究者独立筛选文献、提取资料,运用RevMan 5.2和Stata 13.1软件对纳入的文献进行系统评价及发表偏倚检验。结果纳入17篇文献,共计1588例病人。Meta分析结果显示:观察组在提高临床疗效[OR=5.66,95%CI(3.68,9.48),P<0.05]及心电图有效率[OR=3.71,95%CI(2.12,6.49),P<0.05]、缓解胸痛症状[OR=5.03,95%CI(2.88,8.77),P<0.05]、减少胸痛发作频率[SMD=-0.62,95%CI(-0.81,-0.43),P<0.00001]、延长病人总运动时间[MD=60.28,95%CI(29.33,91.23),P=0.0001]、降低运动试验中心电图ST段压低的最大幅度[MD=-0.21,95%CI(-0.32,-0.10),P=0.0002]、增加一氧化氮水平[MD=24.60,95%CI(18.60,30.60),P<0.00001]、降低内皮素-1[SMD=-1.81,95%CI(-2.88,-0.73),P=0.001]与超敏C反应蛋白水平[MD=-2.79,95%CI(-3.08,-2.50),P<0.00001]方面优于对照组,但在不良反应发生率及胸痛持续时间方面差异无统计学意义。结论现有证据表明尼可地尔联合常规抗心绞痛药物,可明显提高微血管性心绞痛病人临床疗效及心电图有效率,缓解心绞痛症状,减少胸痛发作频率,亦可明显延长病人总运动时间,降低ST段压低的最大幅度,明显改善血管内皮功能,且未增加不良反应事件的发生率及延长心绞痛持续时间。
Objective To review the clinical efficacy of nicorandil in the treatment of microvascular angina(MVA)and its effects on vascular endothelial function.Methods Randomized controlled trials(RCTs)published in China Knowledge Network(CNKI),Chongqing Weipu(VIP)Database,Wanfang Database,PubMed,the Cochrane Library,and EMbase from their inception to October 2019 were searched.Two reviewers independently reviewed the literature and extracted data.Systematic evaluation and publication bias testing of the included studies were analysed by RevMan 5.2 and Stata13.1 software.Results Seventeen RCTs involving 1588 patients were included.The results of Meta-analysis showed that,compared with control group,the clinical efficacy[OR=5.66,95%CI(3.68,9.48),P<0.05]and electrocardiogram(ECG)effective rate[OR=3.71,95%CI(2.12,6.49),P<0.05]were improved,chest pain symptoms were alleviated[OR=5.03,95%CI(2.88,8.77),P<0.05],onset times of angina pectoris decreased[SMD=-0.62,95%CI(-0.81,-0.43),P<0.00001],the total exercise time of MVA patients was prolonged[MD=60.28,95%CI(29.33,91.23),P=0.0001],maximum ST segment depression extent was reduced[MD=-0.21,95%CI(-0.32,-0.10),P=0.0002],nitric oxide(NO)level increased[MD=24.60,95%CI(18.60,30.60),P<0.00001],endothelin-1(ET-1)level[SMD=-1.81,95%CI(-2.88,-0.73),P=0.001]and hs-CRP level[MD=-2.79,95%CI(-3.08,-2.50),P<0.00001]decreased in observation group.There were no statistically significant difference in the incidence of adverse events and duration of the angina pectoris.Conclusion Current studies show that compared with the conventional anti-angina drugs,nicorandil can significantly improve the clinical efficacy and ECG efficiency,relieve thesymptoms of chest pain,reduce onset times of angina pectoris,prolong the total exercise time,reduce the maximum amplitude of ST-segment depression in electrocardiogram,improve vascular endothelial function,without increasing the incidence of adverse events.
作者
冯浩欣
惠泽民
谢蓓莉
赵福海
FENG Haoxin;HUI Zemin;XIE Beili;ZHAO Fuhai(Graduate School of China Academy of Chinese Medical Sciences,Beijing 100070,China,Cardiovascular Diseases Center,Xiyuan Hospital,China Academy of Chinese Medical Sciences,Beijing 100091,China)
出处
《中西医结合心脑血管病杂志》
2021年第18期3087-3093,3140,共8页
Chinese Journal of Integrative Medicine on Cardio-Cerebrovascular Disease
基金
国家自然科学基金资助项目(No.81774139)。
