目的 評(píng)價(jià)厄貝沙坦氫氯噻嗪合用甲狀腺素治療重癥心力衰竭（CHF）的療效和安全性。方法 檢索中國(guó)學(xué)術(shù)期刊全文數(shù)據(jù)庫(kù)（CNKI）、維普中文科技期刊全文數(shù)據(jù)庫(kù)（VIP）、中國(guó)生物醫(yī)學(xué)數(shù)據(jù)庫(kù)（CBM）、萬方醫(yī)學(xué)期刊全文數(shù)據(jù)庫(kù)、Pubmed、EmBase，檢索時(shí)限為2000年1月-2018年11月。收集厄貝沙坦氫氯噻嗪聯(lián)用甲狀腺素治療CHF的臨床隨機(jī)對(duì)照研究（RCT），采用Cochrane風(fēng)險(xiǎn)偏倚評(píng)估工具評(píng)價(jià)納入研究的質(zhì)量，使用統(tǒng)計(jì)軟件Revman 5.2進(jìn)行Meta-分析。結(jié)果 共納入14項(xiàng)RCTs，總計(jì)1 184例。Meta-分析結(jié)果顯示：厄貝沙坦氫氯噻嗪聯(lián)用甲狀腺素能顯著提高顯效率（OR=2.08，95% CI=1.63~2.65，P<0.001），提高左心室射血分?jǐn)?shù)（LVEF%）水平（MD=7.73，95% CI=7.27~8.19，P<0.001），降低美國(guó)紐約心臟病學(xué)會(huì)（NYHA）分級(jí)（MD=-0.56，95% CI=-0.65~-0.48，P<0.001），增加三碘甲狀腺原氨酸（T3）濃度（MD=0.28，95% CI=0.27~0.30，P<0.001）和甲狀腺素（T4）濃度（MD=18.98，95% CI=17.52~20.44，P<0.001）均優(yōu)于對(duì)照組；兩組不良反應(yīng)發(fā)生率無統(tǒng)計(jì)學(xué)差異（OR=1.47，95% CI=0.54~3.99，P=0.45）。結(jié)論 厄貝沙坦氫氯噻嗪聯(lián)用甲狀腺素可顯著改善CHF患者心功能指標(biāo)，提高甲狀腺激素水平，且安全性較好。

Objective To systematically review the efficacy and safety of irbesartan/hydrochlorothiazide combined with thyroxine in treatment of chronic heart failure (CHF). Methods CNKI, VIP, CBM, WanFang Database, PubMed, and EmBase were retrieved online to collect randomized controlled trials about irbesartan/hydrochlorothiazide combined with thyroxine in treatment of CHF from January 2000 to October 2018. The Cochrane risk bias assessment tool was used to evaluate the quality of the study, and the Meta-analysis was carried out with the statistical software Revman 5.2. Results A total of 1 184 patients were involved in 14 RCTs. Meta-analysis results showed that the cure rates (OR=2.08, 95%CI=1.63-2.65, P<0.001), improvement of LVEF% (MD=7.73, 95%CI=7.27-8.19, P<0.001), decrease of NYHA grade (MD=-0.56, 95%CI=-0.65--0.48, P<0.001), improvement of T3 level (MD=0.28, 95%CI=0.27-0.30, P<0.001) and T4 level (MD=18.98, 95%CI=17.52-20.44, P<0.001) in the irbesartan/hydrochlorothiazide combined with thyroxine group were significantly better than control group. There was no significant difference in the incidence of adverse reactions (OR=1.47, 95%CI=0.54-3.99, P=0.45). Conclusion Irbesartan/hydrochlorothiazide combined with thyroxine can significantly improve cardiac function indexes in patients with CHF, and improve the level of thyroid hormone, and the safety is good.

湖北省自然科學(xué)基金資助項(xiàng)目（ZRZ2015000316）