中国实用儿科杂志

中国实用儿科杂志 ›› 2026, Vol. 41 ›› Issue (2): 166-171.DOI: 10.19538/j.ek2026020616

• 论著 • 上一篇    下一篇

伊伐布雷定治疗射血分数保留型心衰有效性的 Meta 分析

  

  1. 重庆医科大学附属儿童医院心血管科  国家临床心血管内科重点专科  国家儿童健康与疾病临床医学研究中心  儿童发育疾病研究教育部重点实验室  重庆市卫生健康委儿童重要器官发育与疾病重点实验室，重庆  400014
  • 出版日期:2026-02-06 发布日期:2026-03-13
  • 通讯作者: 孙慧超，电子信箱：cqmushc@hospital.cqmu.edu.cn
  • 基金资助:
    中华心血管病发展专项基金（Z-2019-42-1908-2）

Efficacy of ivabradine in the treatment of heart failure with preserved ejection fraction： a Meta-analysis

  1. Department of Cardiology，National Clinical Key Cardiovascular Specialty，National Clinical Research Center for Child Health and Disorders，Ministry of Education Key Laboratory of Child Development and Disorders，Key Laboratory of Children’s Vital Organ Development and Diseases of Chongqing Health Commission，Children’s Hospital of Chongqing Medical University，Chongqing 400014，China
  • Online:2026-02-06 Published:2026-03-13

摘要： 目的　 研究伊伐布雷定在治疗射血分数保留型心衰（HFpEF）中的有效性。方法　分别以中文关键词“伊伐布雷定”“射血分数保留”“心力衰竭”和英文关键词“ivabradine”“preserved ejection fraction”“heart failure”检索中国知网、万方数据库、维普数据库、中国生物医学数据库等中文数据库和Pubmed、Embase、Cochrane、Web of science等英文数据库，查找所有关于伊伐布雷定治疗 HFpEF的临床随机对照试验，根据纳入标准筛选出符合条件的文献，提取文章中的结局指标如：心率（HR）、N末端前体脑钠肽（NT-proBNP）、左室射血分数（LVEF）、6 min步行实验（6MWT）、左心房容积指数（LAVI）、二尖瓣前向血流E波/二尖瓣环组织多普勒e波比值（E/e’）、舒张早期二尖瓣血流速度峰值/舒张晚期二尖瓣流速（E/A）、左心室舒张末期容积指数（LVEDVI）、不良反应，对纳入文献进行风险偏倚评价，采用RevMan 5.3系统对所提取数据进行统计分析，并对最终结果进行讨论。结果　最终纳入6篇文献，共计607例试验对象。最终研究结果表明：伊伐布雷定较常规药物治疗组在降低心率（MD=-9.91，95%CI -12.46~ -7.36，P<0.001）、降低心衰指标NT-proBNP（MD=-110.24，95%CI -124.47~ -96.02，P<0.001）、提高运动能力指标6MWT（MD=55.46，95%CI 44.35~ 66.58，P<0.001）方面具有统计学意义，而在LAVI、LVEDVI、LVEF、E/A比值、E/e’不良反应发生率方面差异无统计学意义。结论　在HFpEF治疗中，常规抗心衰药物联合伊伐布雷定在降低心率、降低心衰指标NT-proBNP、提高运动能力指标6MWT的疗效优于单用常规抗心衰药物治疗。

关键词:

Abstract: Objective　The objective is to study the efficacy of ivabradine in the treatment of heart failure with preserved ejection fraction（HFpEF）. Methods　We searched China National Knowledge Infrastructure（CNKI），Wanfang database，VIP database，and China Biomedical database（CBM）as well as PubMed，Embase，Cochrane and Web of Science for all available randomized controlled trials（RCTs）on ivabradine in the treatment of heart failure with preserved ejection fraction.Search terms included “ivabradine”，“preserved ejection fraction”，“heart failure” in both Chinese and English.These articles were further screened based on inclusion and exclusion criteria.We extracted the outcome indicators such as heart rate （HR），N-terminal pro-brain natriuretic peptide （NT-proBNP）， left ventricular ejection fraction （LVEF）， 6-minute walking test （6MWT）， left atrial volume index（LAVI），mitral antegrade flow E wave/mitral annular tissue Doppler e wave ratio（E/e’），peak early diastolic mitral flow velocity/late diastolic mitral flow velocity（E/A），left ventricular end-diastolic volume index（LVEDVI）and adverse reactions.The risk bias assessment was conducted on the literatures included， the data extracted were statistically analyzed by the RevMan 5.3 system， and the final results were discussed. Results　Six articles with a total of 607 trial subjects were finally included in the study.The final study results showed that ivabradine was more effective than conventional drug treatment in reducing heart rate（MD=-9.91，95% CI： -12.46 — -7.36，P<0.001）and NT-proBNP（MD=-110.24，95% CI：-124.47 — -96.02，P<0.001），and in improving 6MWT（MD=55.46，95%CI： 44.35 — 66.58，P<0.001），while there were no statistically significant differences in LAVI，LVEDVI，LVEF，E/A ratio，E/e’ or incidence of adverse reactions. Conclusion　Conventional drugs combined with ivabradine were more effective than conventional drugs alone in lowering heart rate and NT-proBNP，and improving 6MWT in the treatment of HFpEF.

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