目的 系統(tǒng)評價曲美他嗪聯(lián)用血管緊張素轉(zhuǎn)化酶抑制劑（ACEI）治療慢性心力衰竭的療效和安全性。方法 檢索PubMed、Embase、中國生物醫(yī)學(xué)文獻數(shù)據(jù)庫（CBM）、中國學(xué)術(shù)期刊全文數(shù)據(jù)庫（CNKI）、維普中文期刊全文數(shù)據(jù)庫（VIP）和萬方數(shù)據(jù)庫，收集曲美他嗪聯(lián)用ACEI（試驗組）對比單用ACEI（對照組）治療慢性心力衰竭的隨機對照研究（RCT），檢索時間為2000年1月—2019年3月，采用RevMan 5.3軟件進行Meta-分析。結(jié)果 共納入13個RCTs，包括1 232例患者，4種ACEI類藥物。Meta-分析結(jié)果顯示：試驗組總有效率（OR=2.88，95% CI=2.10～3.94，P<0.01），治療前后的左心室射血分?jǐn)?shù)增加值（MD=3.83，95% CI=3.28～3.47，P<0.01）、早期血流峰速率與晚期血流峰速率比值增加值（MD=0.16，95% CI=0.09～0.22，P<0.01）、6 min步行試驗增加值（MD=49.20，95% CI=42.52～55.88，P<0.01）、N末端-B型利鈉肽原減少值（MD=-0.87，95% CI=-0.95～-0.79，P<0.01）、腫瘤壞死因子-α減少值（MD=-7.07，95% CI=-7.64～-6.50，P<0.01）和超敏C-反應(yīng)蛋白減少值（MD=-2.54，95% CI=-3.41～-1.66，P<0.01）均顯著大于對照組。不良反應(yīng)發(fā)生率無統(tǒng)計學(xué)差異（OR=1.78，95% CI=0.67～4.72，P>0.05）。結(jié)論 曲美他嗪聯(lián)用ACEI治療慢性心力衰竭臨床療效優(yōu)于單用ACEI，安全性相當(dāng)。

Objective To evaluate the efficacy and safety of Trimetazidine combined with angiotensin converting enzyme inhibitor (ACEI) in the treatment of chronic heart failure. Methods The randomized controlled trials of Trimetazidine combined with ACEI (Test group) vs ACEI alone (Control group) of treatment of chronic heart failure were searched from the database including Pubmed, Embase, CBM, CNKI, VIP and Wangfang data by computer from Jan. 2000 to Mar. 2019. Meta-analysis was performed using RevMan 5.3 software. Results A total of 13 RCTs, 1 232 patients and 4 kinds of ACEI drugs were included. Meta-analysis showed that total effective rate (OR=2.88, 95%CI=2.10-3.94, P<0.01), increase of left ventricular ejection fraction (LVEF%) before and after treatment (MD=3.83, 95% CI=3.28-3.47, P<0.01), ratio of early peak velocity to late peak velocity (E/A) (MD=0.16, 95%CI=0.09-0.22, P<0.01), added value of 6-min walking test (6MWD) (MD=49.20, 95%CI=42.52-55.88, P<0.01), reduction of Nterminal-b-type natriuretic peptide reduction (NT-proBNP) reduction (MD=-0.87, 95%CI=-0.95--0.79, P<0.01), decrease of TNF-α (MD=-7.07, 95%CI=-7.64--6.50, P<0.01) and hs-CRP reduction (MD=-2.54, 95%CI=-3.41--1.66, P<0.01) of test group much higher than that of control group. There was no significant difference in the rate of ADR (OR=1.78, 95%CI=0.67-4.72, P>0.05). Conclusion The available evidence suggests that the efficacy of trimetazidine in combination with ACEI in the treatment of chronic heart failure is superior to that of ACEI alone.

湖北省自然科學(xué)基金（ZRZ2015000316）