不同时间服用小剂量阿司匹林对高血压患者血压影响的Meta分析(1)
摘要：目的 評价高血压患者在睡前与晨起服用小剂量阿司匹林对血压的影响。方法 通过计算机检索中国知网、维普数据库、中国生物医学文献数据库、万方数据库、Cochrane Library、Pubmed、Web of Science数据库，检索时限至2018年10月，按照纳入和排除标准由2名评价者独立筛选并提取资料，采用Cochrane 5.1手册提供的偏椅风险评估方法，对纳入研究进行治疗评价后，采用RevMan 5.3软件进行Meta分析。结果 共纳入7篇文献，共1102例。Meta分析结果显示：睡前与晨起服用小剂量阿司匹林对收缩压的影响，进行异质性检验结果示(？字2=57.50，P<0.00001，I2=90%)。采用随机效应模型，结果示(MD -3.74，95%CI(-7.11，-0.38)，Z=2.18，P=0.03)。剔除丘文山[7]、董军亚[8]、廖承广[9]等研究后，采用固定效应模型进行Meta分析，结果示(MD-2.09，95%CI(-3.84，-0.33)，Z=2.33，P=0.02)，睡前服用小剂量阿司匹林降低高血压患者收缩压优于晨起服用(P<0.05);睡前与晨起服用小剂量阿司匹林对舒张压的影响， 进行异质性检验结果示(？字2=40.21，P<0.00001，I2=85%)，采用随机效应模型，结果示(MD -2.63，95%CI(-4.71，-0.55)，Z=2.48，P=0.01)。剔除董军亚[8]、廖承广[9]研究后，采用固定效应模型进行分析，睡前与晨起服用小剂量阿司匹林对高血压患者舒张压影响比较，差异无统计学意义(MD -0.85，95%CI(-1.91，0.21)，Z=1.57，P=0.12)。结论 睡前服用小剂量阿司匹林较晨起服用可能降低高血压患者的收缩压，尚不能确定是否降低舒张压。鉴于研究样本量少及部分文献质量限制，论证强度受到一定限制，因此尚需进一步开展高质量、大样本随机对照试验对本研究结果予以验证，从而为临床提供更可靠的证据。
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关键词：阿司匹林;服药时间;高血压;Meta分析
中图分类号：R544.1 文献标识码：A DOI：10.3969/j.issn.1006-1959.2019.06.030
文章编号：1006-1959(2019)06-0097-04
Abstract：Objective To evaluate the effect of low-dose aspirin on blood pressure in patients with hypertension before bedtime and morning. Methods The Chinese Knowledge Network， Weipu Database， China Biomedical Literature Database， Wanfang Database， Cochrane Library， Pubmed， and Web of Science Database were searched by computer. The search time was limited to October 2018， and the two reviewers were independent according to the inclusion and exclusion criteria. The data were screened and extracted， and the meta-analysis was conducted using RevMan 5.3 software after the evaluation of the included studies using the method of risk assessment of the partial chair provided by the Cochrane 5.1 manual. Results A total of 7 articles were included and 1102 patients were included. The results of the meta-analysis showed that the effect of low-dose aspirin on systolic blood pressure before bedtime and morning was tested by heterogeneity test (？字2=57.50， P<0.00001， I2=90%). Using a random effects model， the results are shown (MD-3.74， 95% CI (-7.11，-0.38)，Z= 2.18，P=0.03). After eliminating the research of Qiu Wenshan[7]， Dong Junya[8]， Liao Chengguang[9]， etc.， the meta-analysis was performed using the fixed effect model. The results showed (MD-2.09， 95% CI (-3.84， -0.33)， Z=2.33，P=0.02)， taking low-dose aspirin before bed to reduce the systolic blood pressure of patients with hypertension is better than morning dose (P<0.05); The effect of low-dose aspirin on diastolic blood pressure before bedtime and morning， the heterogeneity test results (？字2=40.21， P<0.00001， I2=85%)， using random effects model， the results showed(MD-2.63， 95 %CI(-4.71，-0.55)，Z=2.48，P=0.01).Excluding the study of Dong Junya[8] and Liao Chengguang[9]， the fixed-effects model was used for analysis.The effect of low-dose aspirin on the diastolic blood pressure of patients with hypertension before and after going to bed was not statistically significant (MD-0.85， 95%CI(-1.91，0.21)，Z=1.57，P=0.12).Conclusion Taking a small dose of aspirin before going to bed may reduce the systolic blood pressure in hypertensive patients. It is not certain whether to reduce diastolic blood pressure. In view of the small sample size and some literature quality restrictions， the intensity of the argument is limited. Therefore， it is necessary to further conduct high-quality， large-sample randomized controlled trials to verify the results of this study， thus providing more reliable evidence for the clinic., 百拇医药(唐一飞 程宝山 王爱玲)
, http://www.100md.com
关键词：阿司匹林;服药时间;高血压;Meta分析
中图分类号：R544.1 文献标识码：A DOI：10.3969/j.issn.1006-1959.2019.06.030
文章编号：1006-1959(2019)06-0097-04
Abstract：Objective To evaluate the effect of low-dose aspirin on blood pressure in patients with hypertension before bedtime and morning. Methods The Chinese Knowledge Network， Weipu Database， China Biomedical Literature Database， Wanfang Database， Cochrane Library， Pubmed， and Web of Science Database were searched by computer. The search time was limited to October 2018， and the two reviewers were independent according to the inclusion and exclusion criteria. The data were screened and extracted， and the meta-analysis was conducted using RevMan 5.3 software after the evaluation of the included studies using the method of risk assessment of the partial chair provided by the Cochrane 5.1 manual. Results A total of 7 articles were included and 1102 patients were included. The results of the meta-analysis showed that the effect of low-dose aspirin on systolic blood pressure before bedtime and morning was tested by heterogeneity test (？字2=57.50， P<0.00001， I2=90%). Using a random effects model， the results are shown (MD-3.74， 95% CI (-7.11，-0.38)，Z= 2.18，P=0.03). After eliminating the research of Qiu Wenshan[7]， Dong Junya[8]， Liao Chengguang[9]， etc.， the meta-analysis was performed using the fixed effect model. The results showed (MD-2.09， 95% CI (-3.84， -0.33)， Z=2.33，P=0.02)， taking low-dose aspirin before bed to reduce the systolic blood pressure of patients with hypertension is better than morning dose (P<0.05); The effect of low-dose aspirin on diastolic blood pressure before bedtime and morning， the heterogeneity test results (？字2=40.21， P<0.00001， I2=85%)， using random effects model， the results showed(MD-2.63， 95 %CI(-4.71，-0.55)，Z=2.48，P=0.01).Excluding the study of Dong Junya[8] and Liao Chengguang[9]， the fixed-effects model was used for analysis.The effect of low-dose aspirin on the diastolic blood pressure of patients with hypertension before and after going to bed was not statistically significant (MD-0.85， 95%CI(-1.91，0.21)，Z=1.57，P=0.12).Conclusion Taking a small dose of aspirin before going to bed may reduce the systolic blood pressure in hypertensive patients. It is not certain whether to reduce diastolic blood pressure. In view of the small sample size and some literature quality restrictions， the intensity of the argument is limited. Therefore， it is necessary to further conduct high-quality， large-sample randomized controlled trials to verify the results of this study， thus providing more reliable evidence for the clinic., 百拇医药(唐一飞 程宝山 王爱玲)