目的 系統(tǒng)評價依那普利葉酸片對比依那普利片治療心力衰竭的療效和安全性，為臨床推廣提供循證醫(yī)學證據。方法 計算機檢索中國學術期刊全文數據庫（CNKI）、中國生物醫(yī)學文獻數據庫（CBM）、維普中文科技期刊數據庫（VIP）、萬方醫(yī)學期刊全文數據庫、PubMed及Cochrane library等數據庫，收集有關依那普利葉酸片對比依那普利片治療心力衰竭的隨機對照研究（RCT），采用Revman 5.3軟件對各研究的N-末端B型利鈉肽前體（NT-proBNP）、同型半胱氨酸（Hcy）、血漿和肽素水平、心臟超聲指標、ADR等進行分析。結果 共納入12項RCT，1 259例患者。Meta-分析顯示：與依那普利片比較，依那普利葉酸片能進一步降低NT-proBNP水平（MD=-0.41，95% CI=-0.43~-0.40，P<0.01）、血漿和肽素水平（MD=-3.02，95% CI=-4.37~-1.68，P<0.01）和Hcy水平（MD=-3.36，95% CI=-4.04~-2.68，P<0.01）；顯著增加LVEF/%（MD=5.00，95% CI=3.58~6.43，P<0.01），降低LVEDD （MD=-4.07，95% CI=-5.74~-2.40，P<0.01）和LVESDD （MD=-3.49，95% CI=-5.23~-1.76，P<0.01）；ADR發(fā)生率（OR=1.00，95% CI=0.42~2.36，P>0.05）無顯著性差異。結論 依那普利葉酸片降低心力衰竭患者NT-proBNP、Hcy和血清和肽素水平，改善心臟功能均優(yōu)于依那普利片，兩種藥物安全性相當。

Objective To systematically evaluate the efficacy and safety of enalapril folic acid tablets vs enalapril tablets in the treatment of heart failure, and provide evidence-based medical evidence for clinical promotion. Methods The related databases of CNKI, CBM, VIP, Wanfang Database, PubMed and Cochrane library were used to identify studies on the efficacy and safety of enalapril folic acid tablets vs enalapril tablets in the treatment of heart failure. The NT-proBNP, Hcy, serum levels of copeptin, cardiac ultrasound index and ADR of studies were analyzed by the RevMan 5.3 software. Results A total of 12 randomized controlled trials were reviewed, and 1 259 patients were included. Meta-analysis result showed that:compared with enalapril tablets, enalapril folic acid tablets further reduced the levels of NT-proBNP (MD=-0.41, 95%CI=-0.43--0.40, P<0.01), serum levels of copeptin (MD=-3.02, 95%CI=-4.37--1.68, P<0.01) and Hcy levels (MD=-3.36, 95%CI=-4.04--2.68, P<0.01); And it significantly increased LVEF/% (MD=5.00, 95%CI=3.58-6.43, P<0.01), and decreased LVEDD (MD=-4.07, 95%CI=-5.74--2.40, P<0.01) and LVESDD (MD=-3.49, 95%CI=-5.23--1.76, P<0.01). The rate of ADR had no significant difference (OR=1.00, 95%CI=0.42-2.36, P> 0.05). Conclusion Enalapril folic acid tablets can reduce the levels of NT-proBNP, Hcy and serum levels of copeptin, and improve cardiac function in patients with heart failure than that of enalapril tablets. The safety of the two drugs is equivalent.

湖北省自然科學基金資助項目（ZRZ2015000316）