兰州大学机构库 >学院待认领
卡维地洛与选择性β肾上腺受体阻滞剂治疗心力衰竭效果的Meta分析
Alternative TitleCarvedilol versus Selective Beta-Adrenergic Receptor Blockade in Patients with Chronic Heart Failure: A Meta- Analysis
钱盾
Thesis Advisor姚亚丽
2013-05-14
Degree Grantor兰州大学
Place of Conferral兰州
Degree Name硕士
Keywordβ受体阻滞剂 卡维地洛 Meta分析 心力衰竭
Abstract背景:第三代非选择性β肾上腺受体阻滞剂卡维地洛具有α、β受体阻滞作用,在大剂量时还具有抗氧化附带特性,与美托洛尔、比索洛尔、倍他洛尔及奈必洛尔选择性β肾上腺受体阻滞剂相比应用于心力衰竭患者可能会获得较好的临床效果。 目的: 应用Meta分析方法评价非选择性β肾上腺受体阻滞剂卡维地洛与选择性β肾上腺受体阻滞剂治疗心力衰竭的临床效果。 资料: PubMed, EMBASE, Cochrane library, web of science, www. clinictrails. com, 相关的学术网站及中文核心杂志。 入选条件:研究卡维地洛与美托洛尔、比索洛尔、倍他洛尔及奈必洛尔应用于治疗心力衰竭的临床随机对照试验,其研究结果包含有治疗前后左心室射血分数、六分钟步行试验、心力衰竭恶化及心源性死亡的发生率。 提取资料:由两名评审员独立检索并对符合纳入标准的研究进行质量评价和资料提取,进行交叉核对,如有争议,则与第三方共同讨论。 合并结果:本研究最终纳入15个研究,共5131例患者。合并结果显示:卡维地洛在降低心脏死亡率方面效果优于第二代选择性β受体阻滞剂(OR, 0.76; 95%CI: 0.65 to 0.88, p=0.0003)。在以下临床结局方面二者具有相同的作用,治疗前后左心室射血分数的改变(WMD, 0.98; 95% CI, -0.50 to 2.47)、六分钟步行试验(WMT, 2.35; 95% CI -3.48 to 8.17 p=0.43、心力衰竭恶化的发生率(OR, 0.97; 95%CI: 0.74 to 1.28, p=0.85)。 结论:本Meta分析结果提示,卡维地洛可改善患者心功能、运动能力及心力衰竭恶化的发生率,与第二代β受体阻滞剂相比能明显降低心力衰竭患者心源 性死亡的发生率。基于GRADE系统的证据等级为中等质量(1B),鉴于所纳入的研究样本量小、质量较低,上述结论尚需要开展大规模、高质量的研究来验证。 基金来源:未获得基金支持。
Other AbstractBackground: Carvedilol, a third generation nonselective beta-adrenergic receptor blockade, have α and β adrenergic receptor blockade and also a widely spectrum of anti-inflammatory activity and might provide comparable or superior clinical outcomes than high selective beta-adrenergic receptor blockade (SBB) such as metoprolol, bisoprolol and betaxolol in patients with heart failure (HF). Purpose: aimed to compare the efficacy of carvedilol and SBB in the treatment of patients with HF in the long run. Date sources: PubMed, EMBASE, Cochrane library, web of science, www. clinictrails. com,relevant academic website ,and some important Chinese journals. Study selection: Randomized, controlled trials including patients with chronic heart failure receiving beta-adrenergic receptor blockade that compared carvedilol with high selective beta-adrenergic receptor blockade such as metoprolol, bisoprolol, betaxolol, and nebivolol. We assessed the following clinic outcomes: ⑴changes in left ventricular ejection fraction (LVEF) from baseline; ⑵exercise capacity (6 minutes walk test); ⑶cardiovascular death; ⑷worsening HF. Date extraction: Two reviewers independently screened potentially eligible studies and cross-checked. Staged discuss by three reviewers when have some different objection on the same article. Date synthesis: Thirteen trials enrolling5131 participants were identified. Thirteen trials enrolling5131 participants were identified. Carvedilol and HBSS did not differ in increasing LVEF, 6-MWT and reducing the incidents of worsening heart failure (WMD, 0.98; 95% CI, -0.50 to 2.47; p=0.19. WMT, 2.35; 95% CI -3.48 to 8.17 p=0.43. OR, 0.97; 95%CI: 0.74 to 1.28, p=0.85, respectively). However, Carvedilol is superior to SBB in reducing cardiovascular death (OR, 0.76; 95%CI: 0.65 to 0.88, p=0.0003). Conclusion: carvedilol as compared against and HBSS in randomized direct comparison trials, significant reduced cardiac mortality in patients with HF and are as effective as SBB in reduction of incidence of worsening the HF and increasing cardiac function and exercise performance. Based on GRADE system, the level of evidence was Grade moderate (1B). However, in view of the limitations of this study, this conclusion still needs to be verified with more large-scale and high-quality RCTs. Primary funding source: none.
URL查看原文
Language中文
Document Type学位论文
Identifierhttps://ir.lzu.edu.cn/handle/262010/223161
Collection学院待认领
Affiliation临床医学院
Recommended Citation
GB/T 7714
钱盾. 卡维地洛与选择性β肾上腺受体阻滞剂治疗心力衰竭效果的Meta分析[D]. 兰州. 兰州大学,2013.
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