目的 系統(tǒng)評(píng)價(jià)卡維地洛聯(lián)合螺內(nèi)酯治療慢性心力衰竭的有效性和安全性。方法 計(jì)算機(jī)檢索PubMed、Cochranelibrary、中國(guó)學(xué)術(shù)期刊全文數(shù)據(jù)庫(kù)（CNKI）、中國(guó)生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫(kù)（CBM）、維普中文期刊全文數(shù)據(jù)庫(kù)（VIP）和萬(wàn)方數(shù)據(jù)庫(kù)，檢索年限為2000年1月至2019年12月，對(duì)符合納入排除標(biāo)準(zhǔn)的隨機(jī)對(duì)照試驗(yàn)（RCT），進(jìn)行數(shù)據(jù)提取和偏倚風(fēng)險(xiǎn)評(píng)價(jià)，然后采用RevMan 5.3軟件進(jìn)行Meta-分析。結(jié)果 最終納入15個(gè)RCTs，共1 594例患者。Meta-分析結(jié)果顯示：卡維地洛聯(lián)合螺內(nèi)酯能顯著提高臨床有效率（RR=1.25，95% CI=1.18~1.32，P<0.01）、降低心率（SMD=-1.58，95% CI=-1.96~-1.21，P<0.01 ）、提高左心室射血分?jǐn)?shù)（SMD=1.22，95% CI=1.04~1.44，P<0.01）和腦鈉肽水平（SMD=- 0.79，95% CI=-0.92~-0.65，P<0.01），未增加藥物不良反應(yīng)發(fā)生率（RR=1.36，95% CI=0.90~2.06，P=0.14），按照對(duì)照組治療方案不同進(jìn)行亞組分析結(jié)果與上述一致。結(jié)論 卡維地洛聯(lián)合螺內(nèi)酯治療慢性心力衰竭的臨床療效優(yōu)于常規(guī)治療或卡維地洛，而安全性相當(dāng)。

Objective To systematically evaluate the effectiveness and safety of carvedilol combined with spironolactone in the treatment of chronic heart failure. Methods Databases of PubMed, Cochrane library, CNKI, CBM, VIP, and Wanfang Database were searched from January 2000 to December 2019, Data extraction and bias risk assessment were performed on randomized controlled trials that met the inclusion exclusion criteria. Meta-analysis was performed using RevMan 5.3 software. Results A total of 15 RCTs involving 1 594 patients were entered. Meta-analysis showed that carvedilol combined with spironolactone could significantly improve clinical effectiveness (RR=1.25, 95% CI=1.18 to 1.32, P<0.01), reduce the heart rate (SMD=-1.58, 95% CI=-1.96 to -1.21, P<0.01), increase left ventricular ejection fraction (SMD=1.22, 95% CI=1.04 to 1.44, P<0.01) and brain natriuretic peptide level (SMD=-0.79, 95% CI=-0.92 to -0.65, P<0.01), and did not increase the incidence of ADR (RR=1.36, 95% CI=0.90 to 2.06, P=0.14). The results of the subgroup analysis according to the treatment plan of the control group were consistent with the above. Conclusion Based on the available evidence, the clinical efficacy of carvedilol combined with spironolactone in chronic heart failure is better than that of conventional treatment or carvedilol with, and and the security is quite.

R972

海南省醫(yī)藥衛(wèi)生科研項(xiàng)目（1901320714A2001）