曲美他嗪治疗稳定型心绞痛疗效与安全性的系统评价_《中国循证医学杂志》

作者：

贺春晖 ¹ ,  马依彤 ¹ , 苏冉 ² , 于子翔 ¹ , 王晓军 ³

1. 新疆医科大学第一附属医院心脏病中心冠心病一科（乌鲁木齐 830054）；2. 新疆医科大学第一附属医院风湿免疫科（乌鲁木齐 830054）；3. 承德市中心医院内分泌科（承德 067000）;

关键词：

曲美他嗪稳定型心绞痛 Meta分析系统评价随机对照试验

DOI：

10.7507/1672-2531.20120114

视频：

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目的系统评价曲美他嗪（Trimetazidine，TMZ）治疗稳定型心绞痛（stable angina pectoris，SAP）的临床疗效和安全性。
方法计算机检索CBM（1989～2011.6）、CNKI（1997～2011.6）、WanFang Data（1989～2011.6）、MEDLINE（1966～2011.6）、EMbase（1974～2011.6）和Cochrane对照试验资料库（1989～2011.6）中有关曲美他嗪治疗稳定型心绞痛的随机对照试验（RCT），按纳入与排除标准选择文献并进行资料提取和质量评价后，采用RevMan 5.0软件进行Meta分析。
结果共纳入15个RCT，1 500例患者。Meta分析结果显示：在平板/踏车试验ST段压低1 mm阈值［WMD=0.84，95%（0.74，0.93），P lt;0.000 01］、运动持续时间［WMD=0.82，95%（0.73，0.91），P lt;0.000 01］、心绞痛发作阈值［WMD=1.18，95%（0.87，1.50），P lt;0.000 01］、每周心绞痛发作次数［WMD=–1.79，95%（–1.93，–1.66），P lt;0.000 01］和每周硝酸甘油消耗量［WMD=–0.60，95%（–0.74，–0.46），P lt;0.000 01]五个方面，曲美他嗪组均明显优于对照组；而在副反应方面，曲美他嗪组与对照组的差异无统计学意义［RR=0.83，95%CI（0.52，1.32），P=0.42］。
结论曲美他嗪治疗稳定型心绞痛疗效优于对照药物，而副反应与对照药物无明显差别，疗效确切，安全性较好。受纳入文献的质量限制及可能存在的发表偏倚影响，本Meta分析结论尚需开展更多高质量、大样本、多中心、随机双盲对照试验加以证实。

引用本文： 贺春晖 ,马依彤,苏冉,于子翔,王晓军. 曲美他嗪治疗稳定型心绞痛疗效与安全性的系统评价. 中国循证医学杂志, 2012, 12(6): 700-707. doi: 10.7507/1672-2531.20120114 复制

1.	Kantor P F, Lucien A, Kozak R, et al. The antianginal drug trimetazidine shifts cardiac energy metabolism from fatty acid oxidation to glucose oxidation by inhibiting mitochondrial long chain 3 ketoacyl coenzyme a thiolase. Circ Res, 2000, 86: 580-588.
2.	Mc Clelian KJ, Plosker GL. Trimetazidine: A review of itsuse in stable angina pectoris and other coronary condition. Drugs, 1999, 58(1): 143-157.
3.	Desideri A, Celegon L. Metabolic management of ischemic heart disease: clinical data with trimetazidine. Am J Cardiol, 1998, 82(5): 50-53.
4.	Cross H R.Trimetazidine for stable angina pectoris. Expert Opin Pharmacother, 2001, (5): 857-875.
5.	Austen WG, Edwards JE, Frye RL, et al. A reporting system on patients evaluated for coronary artery disease. Report of the Ad Hoc Committee for Grading of Coronary Artery Disease, Council on Cardiovascular Surgery, American Heart Association. Circulation, 1975, 51(4Suppl): 5-40.
6.	Jadad AR, Moore RA, Corral D. Assessing the qaulity of the reports of randomized clinical trials :is blinding necessary? Control Clin Trials, 1996, 17(1): 1-12.
7.	Sergio DV, Giuseppe M, Patricia DV, et al. Comparison of Trimetazidine with Nifedipine in Effort Angina:A Double-Blind, Crossover Study. Cardiovascular Drugs and Therapy, 1990, 4: 853-860.
8.	Andreas PM, Konstantinos S, Konstantinos D, et al. Antianginal Efficacy of the Combination of Trimetazidine-Propranolol Compared with Isosorbide Dinatrate-Propranolol in Patients with Stable Angina. Clin Drug Invest, 1997, 1, 13(1): 8-14.
9.	Philippe S, Jean PB. Assessment of Anti-Ischemic and Antianginal Effect at Trough Plasma Concentration and Safety of Trimetazidine MR 35mg in Patients with Stable Angina Pectoris, A multicenter, double blind, placebo controlled study. Am J Cardiovasc Drugs, 2003, 3(5): 361-369.
10.	许嘉鸿, 罗明, 邓兵, 等. 曲美他嗪治疗稳定型心绞痛的疗效和耐受性. 同济大学学报（医学版）, 2003, 24(6): 492-493.
11.	Nevres K, Ahmet K B, Kamil A, et al. Comparison of the effects of trimetazidine and diltiazem on exercise performance in patients with coronary heart disease. The Turkish trimetazidine study (TTS). Acta Cardiol, 2004, 12; 59(6): 644-650.
12.	Ruzyllo W, Szwed H, Sadowski Z, et al. Efficacy of trimetazidine in patients with recurrent angina: a subgroup analysis of the TRIMPOL II study. Current Medical Research and Opinion, 2004, 20(9): 1447-1454.
13.	Hanna S. Clinical benefits of trimetazidine in patients with recurrent angina. Coronary Artery Disease, 2004, 15 (S1): S17-21.
14.	童延清, 李晖. 曲美他嗪治疗稳定型心绞痛的临床研究. 心肺血管病杂志, 2004, 23(1):40.
15.	郑育平, 谢彤. 曲美他嗪治疗慢性肾衰竭合并冠心病稳定型心绞痛的临床疗效. 中国药师, 2004, 7(5): 371-372.
16.	Chazov EI, Lepakchin VK, Zharova EA, et al. Trimetazidine in Angina Combination Therapy-The TACT Study:Trimetazidine versus Conventional Treatment in Patients with Stable Angina Pectoris in a Randomized, Placebo-Controlled, Multicenter Study. American Journal of Therapeutics, 2005, 12(1): 35-42.
17.	周英, 李艳. 曲美他嗪在老年稳定性心绞痛中的作用.吉林医学, 2005, 26(10): 1061-1062.
18.	庞红, 林华, 张金枝. 曲美他嗪治疗稳定型劳力性心绞痛的对照观察.中国医院药学杂志, 2005, 25(12): 1158-1159.
19.	王伯忠, 王雁. 曲美他嗪与辅酶Q10治疗老年慢性稳定型心绞痛的临床观察.心脑血管病防治, 2006, 6(2): 103-105.
20.	张刚, 曹雪滨, 崔英凯,等. 曲美他嗪和倍他乐克联合应用治疗稳定型心绞痛的临床研究.现代中西医结合杂志, 2006, 15(21): 2926-2927.
21.	郑云. 曲美他嗪治疗稳定型心绞痛50例疗效观察. 临床医学, 2010, 23(6): 1858-1859.

1. Kantor P F, Lucien A, Kozak R, et al. The antianginal drug trimetazidine shifts cardiac energy metabolism from fatty acid oxidation to glucose oxidation by inhibiting mitochondrial long chain 3 ketoacyl coenzyme a thiolase. Circ Res, 2000, 86: 580-588.
2. Mc Clelian KJ, Plosker GL. Trimetazidine: A review of itsuse in stable angina pectoris and other coronary condition. Drugs, 1999, 58(1): 143-157.
3. Desideri A, Celegon L. Metabolic management of ischemic heart disease: clinical data with trimetazidine. Am J Cardiol, 1998, 82(5): 50-53.
4. Cross H R.Trimetazidine for stable angina pectoris. Expert Opin Pharmacother, 2001, (5): 857-875.
5. Austen WG, Edwards JE, Frye RL, et al. A reporting system on patients evaluated for coronary artery disease. Report of the Ad Hoc Committee for Grading of Coronary Artery Disease, Council on Cardiovascular Surgery, American Heart Association. Circulation, 1975, 51(4Suppl): 5-40.
6. Jadad AR, Moore RA, Corral D. Assessing the qaulity of the reports of randomized clinical trials :is blinding necessary? Control Clin Trials, 1996, 17(1): 1-12.
7. Sergio DV, Giuseppe M, Patricia DV, et al. Comparison of Trimetazidine with Nifedipine in Effort Angina:A Double-Blind, Crossover Study. Cardiovascular Drugs and Therapy, 1990, 4: 853-860.
8. Andreas PM, Konstantinos S, Konstantinos D, et al. Antianginal Efficacy of the Combination of Trimetazidine-Propranolol Compared with Isosorbide Dinatrate-Propranolol in Patients with Stable Angina. Clin Drug Invest, 1997, 1, 13(1): 8-14.
9. Philippe S, Jean PB. Assessment of Anti-Ischemic and Antianginal Effect at Trough Plasma Concentration and Safety of Trimetazidine MR 35mg in Patients with Stable Angina Pectoris, A multicenter, double blind, placebo controlled study. Am J Cardiovasc Drugs, 2003, 3(5): 361-369.
10. 许嘉鸿, 罗明, 邓兵, 等. 曲美他嗪治疗稳定型心绞痛的疗效和耐受性. 同济大学学报（医学版）, 2003, 24(6): 492-493.
11. Nevres K, Ahmet K B, Kamil A, et al. Comparison of the effects of trimetazidine and diltiazem on exercise performance in patients with coronary heart disease. The Turkish trimetazidine study (TTS). Acta Cardiol, 2004, 12; 59(6): 644-650.
12. Ruzyllo W, Szwed H, Sadowski Z, et al. Efficacy of trimetazidine in patients with recurrent angina: a subgroup analysis of the TRIMPOL II study. Current Medical Research and Opinion, 2004, 20(9): 1447-1454.
13. Hanna S. Clinical benefits of trimetazidine in patients with recurrent angina. Coronary Artery Disease, 2004, 15 (S1): S17-21.
14. 童延清, 李晖. 曲美他嗪治疗稳定型心绞痛的临床研究. 心肺血管病杂志, 2004, 23(1):40.
15. 郑育平, 谢彤. 曲美他嗪治疗慢性肾衰竭合并冠心病稳定型心绞痛的临床疗效. 中国药师, 2004, 7(5): 371-372.
16. Chazov EI, Lepakchin VK, Zharova EA, et al. Trimetazidine in Angina Combination Therapy-The TACT Study:Trimetazidine versus Conventional Treatment in Patients with Stable Angina Pectoris in a Randomized, Placebo-Controlled, Multicenter Study. American Journal of Therapeutics, 2005, 12(1): 35-42.
17. 周英, 李艳. 曲美他嗪在老年稳定性心绞痛中的作用.吉林医学, 2005, 26(10): 1061-1062.
18. 庞红, 林华, 张金枝. 曲美他嗪治疗稳定型劳力性心绞痛的对照观察.中国医院药学杂志, 2005, 25(12): 1158-1159.
19. 王伯忠, 王雁. 曲美他嗪与辅酶Q10治疗老年慢性稳定型心绞痛的临床观察.心脑血管病防治, 2006, 6(2): 103-105.
20. 张刚, 曹雪滨, 崔英凯,等. 曲美他嗪和倍他乐克联合应用治疗稳定型心绞痛的临床研究.现代中西医结合杂志, 2006, 15(21): 2926-2927.
21. 郑云. 曲美他嗪治疗稳定型心绞痛50例疗效观察. 临床医学, 2010, 23(6): 1858-1859.

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曲美他嗪治疗稳定型心绞痛疗效与安全性的系统评价

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《中国循证医学杂志》

曲美他嗪治疗稳定型心绞痛疗效与安全性的系统评价

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