Chinese Medical Sciences Journal ›› 2020, Vol. 35 ›› Issue (3): 226-238.doi: 10.24920/003678
林烨1,王祯莲1,严敏1,朱飞雨1,端烨1,孙志琴2,*()
收稿日期:
2020-01-13
出版日期:
2020-09-30
发布日期:
2020-09-25
通讯作者:
孙志琴
E-mail:sun_zhiqin@163.com
Lin Ye1,Wang Zhenlian1,Yan Min1,Zhu Feiyu1,Duan Ye1,Sun Zhiqin2,*()
Received:
2020-01-13
Published:
2020-09-30
Online:
2020-09-25
Contact:
Sun Zhiqin
E-mail:sun_zhiqin@163.com
摘要:
目的 探讨曲美他嗪对糖尿病合并冠心病患者的治疗作用。
方法 我们检索PubMed,EMBASE和Cochrane数据库中2019年5月之前收录的所有关于曲美他嗪对糖尿病合并冠心病患者疗效的随机对照研究。采用Cochrane Collaboration推荐的偏倚风险评估方法评估文献质量。采用用随机或固定模型获得左心室功能、血清葡萄糖代谢、血清脂代谢、心肌缺血发作和运动耐量的合并平均差异,效应大小由95%置信区间(CI)表示。
结果 曲美他嗪辅助治疗有助于改善患者的左心室射血分数(WMD=4.39,95%CI:3.83,4.95,P<0.00001),左心室舒张末期直径(WMD=-3.17,95%CI:-4.90,-1.44,P=0.0003)和左心室收缩末期直径(WMD=-4.69,95%CI:-8.66,-0.72,P=0.02)。曲美他嗪还能降低空腹血糖(SMD=-0.43,95%CI:-0.70,-0.17,P=0.001)、糖基化血红蛋白水平(WMD=-0.59,95%CI:-0.95,-0.24,P=0.001),血清总胆固醇水平(WMD=-20.36,95%CI:-39.80,-0.92,P=0.04)、低密度脂蛋白胆固醇水平(WMD=-20.12,95%CI:-32.95,-7.30,P=0.002),心肌缺血发作的发生率(SMD=-0.84,95%CI:-1.50,-0.18,P=0.01)。然而,曲美他嗪不能显著降低血清甘油三酯及高密度脂蛋白胆固醇水平,改善运动耐量。
结论 曲美他嗪辅助治疗能有效改善糖尿病合并冠心病患者的心功能、血糖、血脂代谢及临床症状。
Lin Ye, Wang Zhenlian, Yan Min, Zhu Feiyu, Duan Ye, Sun Zhiqin. Effect of Trimetazidine on Diabetic Patients with Coronary Heart Diseases: A Meta-Analysis of Randomized, Controlled Trials[J].Chinese Medical Sciences Journal, 2020, 35(3): 226-238.
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Study | Study design | Location | Number of case | Group (n) | Male (n) | Age (mean, yrs) | Treatment | Inclusion criteria | Outcomes | Follow-up (mon) |
---|---|---|---|---|---|---|---|---|---|---|
Fragasso et al.[ | Crossover | Canada | 16 | T (8) C (5) | 8 5 | 64 64 | 20 mg TMZ tid placebo | DM, ischemic cardiomyopathy, LVEF≤45% | Echocardiogram, exercise tolerance, glucose levels, HbA1c, ET-1 | 6 |
Rosano et al.[ | Parallel | Italy | 32 | T (16) C (16) | 11 13 | 66 65 | 20 mg TMZ tid placebo | DM, ischemic cardiomyopathy, LVEF<50% | Echocardiogram | 6 |
Marazzi et al.[ | Parallel | Italy | 63 | T (15) C (15) | 12 10 | 66 68 | 20 mg TMZ tid placebo | DM, chronic stable angina | Number and duration of silent and symptomatic ischemia episodes | 6 |
Ribeiro et al.[ | Crossover | Brazil | 10 | T (5) C (5) | 6 | 62 | 20 mg TMZ tid placebo | DM, stable angina | Clinical and biochemical evaluations, exercise testing, 24-hour ambulatory blood pressure, Holter monitoring | 1.5 |
Belardinelli et al.[ | Parallel | Italy | 35 | T (19) C (15) | 16 13 | 54 54 | 20 mg TMZ tid placebo | DM, ischemic cardiomyopathy | Myocardial scintigraphy, blood chemistry | 3 |
Shehata et al.[ | Parallel | Egypt | 100 | T (50) C (50) | 31 29 | 60 59 | 70 mg LD+35 mg TMZ bid placebo | DM, anterior wall STEMI treated with thrombolysis | Myocardial enzyme, degree of ST-segment resolution, echocardiogram, adverse events | 6 |
Xu et al.[ | Parallel | China | 510 | T (255) C (255) | 172 174 | 69 69 | 20 mg TMZ tid placebo | DM, multivessel CHD after DES implantation | Incidence of recurrent angina pectoris, echocardiographic, clinical outcomes | 24 |
Li et al.[ | Parallel | China | 180 | T (89) C (84) | 62 58 | 63 64 | 60 mg LD+20 mg TMZ tid placebo | DM, AMI undergoing PCI | Myocardial enzyme, liver function, glucose levels, echocardiogram | 0.5 |
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