长效CCB在高血压伴肾脏疾病治疗中的地位--培训课件.pptVIP

手性药物（chiral drug），是指药物分子结构中引入手性中心后，得到的一对互为实物与镜像的对映异构体。这些对映异构体的理化性质基本相似，仅仅是旋光性有所差别，分别被命名为R-型（右旋）或S-型（左旋）、外消旋。 * * 前面的比较可以看出左旋氨氯地平降压效果优于常见的CCB，如络活喜、波依定、拜新同等，下面我们来看一下左旋氨氯地平和络活喜的疗效比较，北京大学第三医院药剂科主任翟所迪教授荟萃分析了国内学者所作的左旋氨氯地平和络活喜的研究结果，比较了二者的疗效Abstract? Background: Amlodipine is a calcium channel blocker prescribed for the management of angina and hypertension. As a racemic mixture, amlodipine contains (R)- and (S)-amlodipine isomers, but only (S)-amlodipine as the active moiety possesses therapeutic activity. Based on pharmacologic research, it remains uncertain if (S)-amlodipine alone has similar efficacy and fewer associated adverse events (AEs) compared with the racemic mixtures. Objective: The aim of this systematic review and meta-analysis was to determine the effectiveness and tolerability of (S)-amlodipine compared with that of racemic amlodipine. Methods: A systematic literature search was performed using MEDLINE (1966–2009), EMBASE (1966–2009), the Cochrane Central Register of Controlled Trials (issue 3, 2009), the Chinese Biomedical Database (1978–2009), and the China National Knowledge Internet (1980–2009). All randomized controlled trials (RCTs) comparing (S)-amlodipine 2.5 mg and racemic amlodipine 5.0 mg in the treatment of hypertension were included in the review. The outcome measures to be collected were cardiovascular events, systolic blood pressure (SBP), diastolic BP (DBP), and AEs. Quality assessments of clinical trials were conducted using a modified Jadad Scale, with trials being rated as low quality (score 0–3) or high quality (score 4–7). Meta-analysis of the included studies was performed using RevMan software. Results: Of the 229 references identified, 214 were excluded after screening the titles, abstracts, or full texts. Fifteen RCTs were included, of which 13 were in Chinese and 2 in English. Based on the Jadad Scale score, 3 of the RCTs were classified as high quality (score 5 or 6) and the remaining 12 as low quality (score 1–3). None of the tri