目的 系统评价曲美他嗪联用血管紧张素转化酶抑制剂（ACEI）治疗慢性心力衰竭的疗效和安全性。方法 检索PubMed、Embase、中国生物医学文献数据库（CBM）、中国学术期刊全文数据库（CNKI）、维普中文期刊全文数据库（VIP）和万方数据库，收集曲美他嗪联用ACEI（试验组）对比单用ACEI（对照组）治疗慢性心力衰竭的随机对照研究（RCT），检索时间为2000年1月—2019年3月，采用RevMan 5.3软件进行Meta-分析。结果 共纳入13个RCTs，包括1 232例患者，4种ACEI类药物。Meta-分析结果显示：试验组总有效率（OR=2.88，95% CI=2.10～3.94，P<0.01），治疗前后的左心室射血分数增加值（MD=3.83，95% CI=3.28～3.47，P<0.01）、早期血流峰速率与晚期血流峰速率比值增加值（MD=0.16，95% CI=0.09～0.22，P<0.01）、6 min步行试验增加值（MD=49.20，95% CI=42.52～55.88，P<0.01）、N末端-B型利钠肽原减少值（MD=-0.87，95% CI=-0.95～-0.79，P<0.01）、肿瘤坏死因子-α减少值（MD=-7.07，95% CI=-7.64～-6.50，P<0.01）和超敏C-反应蛋白减少值（MD=-2.54，95% CI=-3.41～-1.66，P<0.01）均显著大于对照组。不良反应发生率无统计学差异（OR=1.78，95% CI=0.67～4.72，P>0.05）。结论 曲美他嗪联用ACEI治疗慢性心力衰竭临床疗效优于单用ACEI，安全性相当。

Objective To evaluate the efficacy and safety of Trimetazidine combined with angiotensin converting enzyme inhibitor (ACEI) in the treatment of chronic heart failure. Methods The randomized controlled trials of Trimetazidine combined with ACEI (Test group) vs ACEI alone (Control group) of treatment of chronic heart failure were searched from the database including Pubmed, Embase, CBM, CNKI, VIP and Wangfang data by computer from Jan. 2000 to Mar. 2019. Meta-analysis was performed using RevMan 5.3 software. Results A total of 13 RCTs, 1 232 patients and 4 kinds of ACEI drugs were included. Meta-analysis showed that total effective rate (OR=2.88, 95%CI=2.10-3.94, P<0.01), increase of left ventricular ejection fraction (LVEF%) before and after treatment (MD=3.83, 95% CI=3.28-3.47, P<0.01), ratio of early peak velocity to late peak velocity (E/A) (MD=0.16, 95%CI=0.09-0.22, P<0.01), added value of 6-min walking test (6MWD) (MD=49.20, 95%CI=42.52-55.88, P<0.01), reduction of Nterminal-b-type natriuretic peptide reduction (NT-proBNP) reduction (MD=-0.87, 95%CI=-0.95--0.79, P<0.01), decrease of TNF-α (MD=-7.07, 95%CI=-7.64--6.50, P<0.01) and hs-CRP reduction (MD=-2.54, 95%CI=-3.41--1.66, P<0.01) of test group much higher than that of control group. There was no significant difference in the rate of ADR (OR=1.78, 95%CI=0.67-4.72, P>0.05). Conclusion The available evidence suggests that the efficacy of trimetazidine in combination with ACEI in the treatment of chronic heart failure is superior to that of ACEI alone.

湖北省自然科学基金（ZRZ2015000316）