二甲双胍对冠心病患者全因和心血管死亡率的影响：系统评价和更新的荟萃分析。

BACKGROUND: Metformin is the most widely prescribed drug to lower glucose and has a definitive effect on the cardiovascular system. The goal of this systematic review and meta-analysis is to assess the effects of metformin on mortality and cardiac function among patients with coronary artery disease (CAD). METHODS: Relevant studies reported before October 2018 was retrieved from databases including PubMed, EMBASE, Cochrane Library and Web of Science. Hazard ratio (HR) was calculated to evaluate the all-cause mortality, cardiovascular mortality and incidence of cardiovascular events (CV events), to figure out the level of left ventricular ejection fraction (LVEF), creatine kinase MB (CK-MB), type B natriuretic peptide (BNP) and to compare the average level of low density lipoprotein (LDL). RESULTS: In this meta-analysis were included 40 studies comprising 1,066,408 patients. The cardiovascular mortality, all-cause mortality and incidence of CV events were lowered to adjusted HR (aHR) = 0.81, aHR = 0.67 and aHR = 0. 83 respectively after the patients with CAD were given metformin. Subgroup analysis showed that metformin reduced all-cause mortality in myocardial infarction (MI) (aHR = 0.79) and heart failure (HF) patients (aHR = 0.84), the incidence of CV events in HF (aHR = 0.83) and type II diabetes mellitus (T2DM) patients (aHR = 0.83), but had no significant effect on MI (aHR = 0.87) and non-T2DM patients (aHR = 0.92). Metformin is superior to sulphonylurea (aHR = 0.81) in effects on lowering the incidence of CV events and in effects on patients who don't use medication. The CK-MB level in the metformin group was lower than that in the control group standard mean difference (SMD) = - 0.11). There was no significant evidence that metformin altered LVEF (MD = 2.91), BNP (MD = - 0.02) and LDL (MD = - 0.08). CONCLUSION: Metformin reduces cardiovascular mortality, all-cause mortality and CV events in CAD patients. For MI patients and CAD patients without T2DM, metformin has no significant effect of reducing the incidence of CV events. Metformin has a better effect of reducing the incidence of CV events than sulfonylureas.

背景：二甲双胍是降低血糖最广泛应用的药物，对心血管系统有明确的作用。本系统回顾和荟萃分析的目的是评估二甲双胍对冠心病（CAD）患者死亡率和心功能的影响。

方法：检索了包括 PubMed、EMBASE、Cochrane 图书馆和 Web of Science 在内的数据库中截至 2018 年 10 月之前发表的相关研究。计算风险比（HR）来评估全因死亡率、心血管死亡率和心血管事件（CV 事件）发生率，以确定左心室射血分数（LVEF）、肌酸激酶 MB（CK-MB）、B 型利钠肽（BNP）的水平，并比较低密度脂蛋白（LDL）的平均水平。

结果：本荟萃分析共纳入 40 项研究，包括 1066408 例患者。CAD 患者使用二甲双胍后，心血管死亡率、全因死亡率和 CV 事件发生率分别降低至调整后的 HR（aHR）=0.81、aHR=0.67 和 aHR=0.83。亚组分析显示，二甲双胍降低了心肌梗死（MI）（aHR=0.79）和心力衰竭（HF）（aHR=0.84）患者的全因死亡率，HF（aHR=0.83）和 2 型糖尿病（T2DM）（aHR=0.83）患者的 CV 事件发生率，但对 MI（aHR=0.87）和非 T2DM 患者（aHR=0.92）无显著影响。与磺脲类药物相比，二甲双胍在降低 CV 事件发生率和在未用药患者中的效果更优（aHR=0.81）。二甲双胍组 CK-MB 水平低于对照组的标准均数差（SMD）=-0.11。没有证据表明二甲双胍改变左心室射血分数（MD=2.91）、B 型利钠肽（MD=-0.02）和低密度脂蛋白（MD=-0.08）。

结论：二甲双胍降低 CAD 患者的心血管死亡率、全因死亡率和 CV 事件发生率。对于 MI 患者和无 T2DM 的 CAD 患者，二甲双胍降低 CV 事件发生率的效果不显著。与磺脲类药物相比，二甲双胍降低 CV 事件发生率的效果更好。