目的 评价厄贝沙坦氢氯噻嗪合用甲状腺素治疗重症心力衰竭（CHF）的疗效和安全性。方法 检索中国学术期刊全文数据库（CNKI）、维普中文科技期刊全文数据库（VIP）、中国生物医学数据库（CBM）、万方医学期刊全文数据库、Pubmed、EmBase，检索时限为2000年1月-2018年11月。收集厄贝沙坦氢氯噻嗪联用甲状腺素治疗CHF的临床随机对照研究（RCT），采用Cochrane风险偏倚评估工具评价纳入研究的质量，使用统计软件Revman 5.2进行Meta-分析。结果 共纳入14项RCTs，总计1 184例。Meta-分析结果显示：厄贝沙坦氢氯噻嗪联用甲状腺素能显著提高显效率（OR=2.08，95% CI=1.63~2.65，P<0.001），提高左心室射血分数（LVEF%）水平（MD=7.73，95% CI=7.27~8.19，P<0.001），降低美国纽约心脏病学会（NYHA）分级（MD=-0.56，95% CI=-0.65~-0.48，P<0.001），增加三碘甲状腺原氨酸（T3）浓度（MD=0.28，95% CI=0.27~0.30，P<0.001）和甲状腺素（T4）浓度（MD=18.98，95% CI=17.52~20.44，P<0.001）均优于对照组；两组不良反应发生率无统计学差异（OR=1.47，95% CI=0.54~3.99，P=0.45）。结论 厄贝沙坦氢氯噻嗪联用甲状腺素可显著改善CHF患者心功能指标，提高甲状腺激素水平，且安全性较好。

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.

湖北省自然科学基金资助项目（ZRZ2015000316）