【作者】 刘明玉； 陶娌娜； 张杰； 张永凯；

【Author】 LiuMingyu;Taolina;Zhangjie;Zhangyongkai;The First Hospital of Jilin University;

【机构】 吉林大学第一医院药学部；

【摘要】 目的:系统评价氨氯地平联合阿托伐他汀治疗高血压合并冠心病的疗效,为临床提供循证参考。方法:使用关键词检索Web of Science、PubMed、Cochrane图书馆、中国学术期刊全文数据库(CNKI)、维普中文期刊全文数据库、万方数据库,收集以氨氯地平联合阿托伐他汀(观察组)相较于单用氨氯地平(对照组)治疗高血压合并冠心病的随机对照试验(RCT),筛选文献,提取资料,根据Cochrane系统评价纳入研究的质量,采用Rev Man 5.3统计软件进行Meta分析,比较两组在降压和改善血脂水平方面的差异及安全性。结果:共纳入14个RCT,计2615例患者。Meta分析结果显示:氨氯地平联合阿托伐他汀较单独用氨氯地平更能有效地降低高血压合并冠心病患者的血压和血脂,舒张压(DBP)降低水平[MD=-6.51,95%CI(-8.12,-4.91),P<0.00001]高于对照组;收缩压(SBP)降低水平[MD=-12.38,95%CI(-14.43,-10.33),P<0.00001]高于对照组;低密度脂蛋白胆固醇(LDL-C)降低水平[MD=-0.40,95%CI(-0.54,0.26),P=0.03]高于对照组;总胆固醇(TC)降低水平[MD=-0.88,95%CI(-1.49,-1.61),P<0.00001]高于对照组;三酰甘油(TG)降低水平[MD=-0.40,95%CI(0.60,-0.20),P=0.0006]高于对照组;高密度脂蛋白胆固醇(HDL-C)升高水平[MD=0.16,95%CI(0.04,0.29),P=0.03]低于对照组。两组患者有效率[OR=4.82,95%CI(2.92,7.95),P=0.74],不良反应发生率[OR=1.09,95%CI(0.77,1.53),P=0.78],比较差异均无统计学意义。结论:高血压合并冠心病患者接受氨氯地平联合阿托伐他汀治疗,较单用氨氯地平能有效地降压、改善血脂水平,提高临床疗效,而不增加不良反应。更多还原

【Abstract】 Objective:To systematically evaluate the efficacy of amlodipine combined with atorvastatin in the treatment of hypertension with coronary heart disease and provide evidence-based reference for clinical practice.Methods: Pubmed, Cochrane library, Web of Science, China academic Journal Full-text Database, WeiPu Chinese Journal Full-text Database, WanFang Database were searched from inception through May 2018 to identify randomized controlled trials(RCT)of amlodipine combined with atorvastatin(observation group) in the treatment of hypertension with coronary heart disease(CHD). Meta-analysis was performed by using Rev Man 5.3 software after quality assessment and data extract. Results: A total of 14 RCTs were included,involving 2615 patients. The results of Meta analysis showed that: amlodipine combined with atorvastatinis more effective than amlodipine alone in lowering blood pressure and blood lipid in patients withhypertension and coronary heart disease,diastolic blood pressure(DBP) lowering level [MD=-6.51,95%CI(-8.12,-4.91),P<0.00001] higher than control group; systolic pressure(SBP)lowering level[MD=-12.38,95%CI(-14.43,-10.33), P<0.00001] higher than control group; low density lipoprotein cholesterol(LDL-C)lowering level[MD=-0.40,95%CI(-0.54,0.26),P=0.03]higher than control group; cholesterol total(TC)lowering level[MD=-0.88,95%CI(-1.49,-1.61),P<0.00001]higher than control group;triacylglycerol(TG)lowering level[MD=-0.40,95%CI(-0.60,-0.20),P=0.0006]higher than control group; high density lipoprotein cholesterol(HDL-C) elevated level[MD=0.16,95%CI(0.04,0.29),P=0.03]lower control group. Effective rate of two groupsofpatients[OR=4.82,95%CI(2.92,7.95),P=0.74],adversereactionrate[OR=1.09,95%CI(0.77,1.53),P=0.78], There was no significant difference between the two groups. Conclusion: The treatment of amlodipine combined with atorvastatin in patients with hypertension and coronary heart disease was more effective than amlodipine alone in lowering blood pressure, improving bloodlipids and improving clinical efficacy without increasing adverse reactions.更多还原