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目的系统评价替米沙坦治疗代谢综合征(MS)的临床疗效和安全性。方法按循证医学的要求,制定相应的纳入、排除标准及其检索策略。通过Cochrane Library、PubMed、EMBASE、中国期刊全文数据库、中文科技期刊全文数据库检索相关的临床对照研究,计算机检索时间从各数据库建库至2010年9月;同时辅助其他检索,纳入替米沙坦治疗MS的随机对照试验(RCT)。两名评价者独立评价纳入研究的质量并用统一的表格提取资料,采用Rev Man5.0软件进行统计分析。比较替米沙坦和缬沙坦、氯沙坦、厄贝沙坦、氨氯地平对血压、血糖、血脂、体质量指数(BMI)、腰围、胰岛素、抵抗素、脂联素、C反应蛋白(CRP)、心率、脉搏波传导速度、血清肌酐、血尿素氮、肾小球滤过率、尿蛋白与肌酐比值(UACR)等指标的治疗效果。结果共纳入7篇RCT,共计479例患者。荟萃分析结果显示:替米沙坦在降低收缩压水平(均数差=1.79,95%CI0.91~2.67)方面优于缬沙坦,但在降低低密度脂蛋白胆固醇水平(均数差=-10.10,95%CI-13.02~-7.18)方面较缬沙坦差,差异均有统计学意义(均P<0.05);替米沙坦在降低收缩压(均数差=6.20,95%CI1.80~10.60)、空腹血糖(均数差=10.72,95%CI1.05~20.39)方面优于氯沙坦,在降低舒张压(均数差=1.00,95%CI0.06~1.94)、空腹血糖(均数差=14.00,95%CI10.95~17.05)方面优于厄贝沙坦,在降低胰岛素抵抗指数(均数差=1.36,95%CI0.26~2.46)方面优于氨氯地平(均P<0.05)。结论替米沙坦对MS的治疗作用在大多方面优于其他相关药物,也有个别指标疗效逊于其他药物,但鉴于纳入研究质量不高,仍需大样本多中心随机对照临床试验进一步证实其临床疗效。
Objective To evaluate the clinical efficacy and safety of telmisartan in the treatment of metabolic syndrome (MS). Methods According to the requirements of evidence-based medicine, formulate corresponding inclusion and exclusion criteria and their retrieval strategies. Through the Cochrane Library, PubMed, EMBASE, Chinese Journal Full-text Database, Chinese Science and Technology Journal Full-text Database search related clinical control study, computer search time from database construction to September 2010; at the same time supporting other searches, including telmisartan treatment MS randomized controlled trial (RCT). Two reviewers independently assessed the quality of the included studies and extracted the data using a uniform table and analyzed the data using Rev Man 5.0 software. The effects of telmisartan and valsartan, losartan, irbesartan and amlodipine on blood pressure, blood glucose, blood lipid, body mass index (BMI), waist circumference, insulin, resistin, adiponectin, C-reactive protein (CRP), heart rate, pulse wave velocity, serum creatinine, blood urea nitrogen, glomerular filtration rate, urinary protein and creatinine ratio (UACR) and other indicators of treatment. Results A total of 7 RCTs were included, totaling 479 patients. Meta-analysis showed that telmisartan was superior to valsartan in lowering systolic blood pressure (mean difference = 1.79, 95% CI 0.91-2.67), but lower in low-density lipoprotein cholesterol (mean difference = -10.10, 95% CI -13.02 ~ -7.18), the differences were statistically significant (all P <0.05); telmisartan was superior to valsartan in reducing systolic pressure (mean difference = 6.20, 95% CI1 .80 ~ 10.60), fasting blood glucose (mean difference = 10.72,95% CI1.05 ~ 20.39) was better than losartan in reducing diastolic blood pressure (mean difference = 1.00,95% CI0.06 ~ 1.94) Fasting blood glucose (mean difference = 14.00,95% CI10.95 ~ 17.05) was better than irbesartan in terms of reducing the insulin resistance index (mean difference = 1.36, 95% CI0.26 ~ 2.46) Level (all P <0.05). Conclusion The therapeutic effect of telmisartan on MS is better than that of other related drugs in most aspects, and some indicators are less effective than other drugs. However, due to the poor quality of the included studies, a large sample of multi-center randomized controlled clinical trials is needed to further confirm its clinical significance Efficacy.