PDF(Pubmed)
Abstract：
Coronary microvascular dysfunction (CMD) is becoming increasingly recognized as an important contributor to the development of ischemic heart diseases. Without obstructive coronary artery disease, the physiological function of the coronary microcirculation can be altered by structural, functional, and molecular factors, leading to myocardial ischemia. CMD can significantly impact the quality of life and prognosis and imposes a huge financial burden on healthcare systems and people. This meta-analysis aims to investigate the efficacy of angiotensin-converting enzyme inhibitors (ACEIs) for treating CMD. A systematic literature review identified randomized controlled trials (RCTs) comparing ACEIs with placebo in CMD patients. Review Manager, 5.3 for Windows, was utilized. Using the Mantel-Haenszel (M-H) method, improvement in coronary flow reserve (CFR) and systolic blood pressure events was pooled as mean difference (MD) in a meta-analysis model with a fixed effect model, whereas the number of chest pain episodes was pooled as MD with a random effect model. Five randomized controlled trials involving 209 patients were included in the analysis. The analysis demonstrated a statistically significant improvement in CFR in the ACEIs group compared to the placebo group (MD -0.3, 95% CI -0.61 to 0.01, P = 0.05). However, there was no significant difference in the number of chest pain episodes between the ACEIs and placebo groups (MD 1.79, 95% CI -3.99 to 7.58, P = 0.54). Similarly, no significant difference in blood pressure change was observed between the two groups (MD 4.02, 95% CI -3.25 to 11.28, P = 0.28). In conclusion, the appropriate treatment for CMD is a source of contention because adequate data is lacking. Our findings suggest that ACEIs may have a positive effect on improving CFR in patients with microvascular angina. However, ACEIs did not demonstrate a significant impact on the number of chest pain episodes or systolic blood pressure in this patient population. Further research, including RCTs with larger sample sizes and longer follow-up durations, is warranted to provide more conclusive evidence on the role of ACEIs in CMD management.
摘要：
冠状动脉微血管功能障碍（CMD）越来越被认为是缺血性心脏病发展的重要因素。没有阻塞性冠状动脉疾病,冠状动脉微循环的生理功能可以通过结构改变，功能，和分子因素，导致心肌缺血.CMD可以显着影响生活质量和预后，并给医疗保健系统和人们带来巨大的经济负担。这项荟萃分析旨在研究血管紧张素转换酶抑制剂（ACEI）治疗CMD的疗效。一项系统的文献综述确定了CMD患者中ACEI与安慰剂的随机对照试验（RCT）。审核经理,5.3对于Windows，被利用。使用Mantel-Haenszel(M-H)方法，冠状动脉血流储备（CFR）和收缩压事件的改善被合并为具有固定效应模型的meta分析模型中的平均差异（MD），而将胸痛发作次数合并为MD,采用随机效应模型.分析中纳入了5项随机对照试验，涉及209例患者。分析表明，与安慰剂组相比，ACEI组的CFR有统计学上的显着改善（MD-0.3，95％CI-0.61至0.01，P=0.05）。然而,ACEI组和安慰剂组胸痛发作次数无显著差异(MD1.79,95%CI-3.99~7.58,P=0.54).同样，两组间血压变化无显著差异(MD4.02,95%CI-3.25~11.28,P=0.28)。总之,由于缺乏足够的数据，因此CMD的适当治疗是争论的根源。我们的研究结果表明，ACEI可能对改善微血管性心绞痛患者的CFR具有积极作用。然而,ACEI对该患者人群的胸痛发作次数或收缩压没有显着影响。进一步研究,包括样本量较大、随访持续时间较长的随机对照试验，有必要就ACEI在CMD管理中的作用提供更确凿的证据。
