他汀联合曲美他嗪对冠状动脉粥样硬化性心脏病炎性因子水平调控及改善心室重构的Meta分析被引量：4

Meta-analysis of statin combined with trimetazidine on the regulation of inflammatory factors in coronary atherosclerotic heart disease and improvement of ventricular remodeling

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摘要目的:系统评价他汀联合曲美他嗪对冠状动脉粥样硬化性心脏病基于inflammasomes/免疫损伤应答学说的炎性因子水平调控及心室重构的改善。方法:计算机检索EMbase、The Cochrane Library、Web of Science、Medline、Pubmed、万方数据(WanFang Data)、中国知网(CNKI)、中国生物医学文献服务系统(CBM)、维普数据库(VIP)共9个数据库,检索时限均为建库至2021年6月7日。人工检索所有纳入研究的参考文献,根据Cochrane系统评价方法,筛选关于阿托伐他汀联合曲美他嗪及常规治疗(抗血小板、控制血压、利尿、扩张冠脉等)对比应用曲美他嗪或他汀类药物联合常规治疗冠状动脉粥样硬化性心脏病患者的中、英文随机对照试验(RCT),并进行纳入文献资料的提取和质量评价,运用RevMan5.4软件进行Meta分析。结局指标包括炎性因子指标:CRP(C反应蛋白)、IL-6(白介素6)、肿瘤坏死因子α(TNF-α),以及心室重构相关结局指标:左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)。结果:最终纳入随机对照试验12项,共计1120例冠心病患者。Meta分析结果:(1)炎性因子方面:他汀联合曲美他嗪组较对照组(单纯应用他汀类药物或曲美他嗪)可显著降低冠心病患者血液CRP[n=770,SMD=-2.70,95%CI(-2.55,--1.40),P<-0.00001]、TNF-α[n=678,SMD=-2.25,95%CI(-3.39,-1.12),P<-0.0001]、IL-6[n=770,SMD=-2.10,95%CI(-3.10,-1.10),P<0.00001]三种炎性因子的表达程度。(2)心室重构方面:他汀联合曲美他嗪组和对照组(单纯应用他汀类药物或曲美他嗪)相比,更能明显降低治疗前冠心病患者的左室收缩末期内径[n=626,SMD=-1.55,95%CI(-2.10,-0.99),P<-0.00001]及左室舒张末期内径[n=626,SMD=-1.18,95%CI[-1.56,-0.80),P<-0.00001]。结论:他汀联合曲美他嗪和对照组相比更能明显降低炎性因子水平,并改善冠心病患者的心室重构。 Objective:To systematically evaluate the effects of statins combined with trimetazidine on the regulation of inflammatory factors and the improvement of ventricular remodeling in coronary atherosclerotic heart disease based on the inflammasomes/immune damage response theory.Methods:Using computer to search for EMbase,The Cochrane Library,Web of Science,Medline,Pubmed,WanFang Data,CNKI,China Biomedical Document Service System(CBM),VIP database(VIP),9databases in total.The search time limit is from the inception of the databases to June 7,2021.All reference documents included in the study were manually searched.According to the Cochrane systematic review method,the information on atorvastatin combined with trimetazidine and conventional treatment(antiplatelet,control blood pressure,diuresis,coronary artery dilation and other expectant treatments)contrast the use of trimetazidine or stains combined with expectant treatment of coronary atherosclerotic heart disease patients in Chinese and English randomized controlled trials(RCT),and conduct the extraction and quality evaluation of the included literature data,using RevMan5.4 software for Meta analysis.Outcome indicators include inflammatory factors:C-reactive protein(CRP),IL-6(interleukin 6),tumor necrosis factorα(TNFα),and ventricular remodeling related outcome indicators:left ventricular end diastolic diameter(LVEDD),left Ventricular end systolic diameter(LVESD).Results:12 randomized controlled trials were included,a total of 1120 patients with coronary heart disease.Meta-analysis results:(1)inflammatory factors:the statin combined with trimetazidine group can significantly reduce the CRP、IL-6、TNF-α’s expression degree in the blood of patients with coronary heart disease compared with the control group(only statins or trimetazidine).CRP[n=770,SMD=-2.70,95%CI(-2.55,-1.40),P<-0.00001],TNF-α[n=678,SMD=-2.25,95%CI(-3.39,-1.12),P<-0.0001],IL-6[n=770,SMD=-2.10,95%CI(-3.10,-1.10),P<0.00001].(2)Ventricular remodeling:Compared with the control group(using statins

作者谷依檬汤紫薇吴艳艳薛梅 GU Yi-meng;TANG Zi-wei;WU Yan-yan;XUE Mei(Cardiovascular Disease Center,Xiyuan Hospital,China Academy of Chinese Medical Sciences,Beijing 100089,China;National Cardiovascular Disease Research Center of Traditional Chinese Medicine,Xiyuan Hospital,China Academy of Chinese Medical Sciences,Haidian District,Beijing 100089,China)

机构地区中国中医科学院西苑医院心血管病中心中国中医科学院西苑医院国家中医心血管病临床医学研究中心

出处《海南医学院学报》 CAS 2023年第3期222-228,234,共8页 Journal of Hainan Medical University

基金国家自然科学基金面上项目(81973686) 国家重点研发计划课题(2019YFC0840608)。