环磷腺苷葡胺治疗慢性心力衰竭的系统评价

Meglumine Adenosine Cyclophosphate for Chronic Heart Failure: A Systematic Review

目的系统评价环磷腺苷葡胺(MAC)治疗慢性心力衰竭的疗效和安全性。方法计算机检索Cochrane图书馆临床对照试验资料库(2011年第3期)、MEDLINE(1950～2011.3)、EMbase(1980～2011.3)、中国期刊全文数据库(1995～2011.3)、中国科技期刊全文数据库(1989～2011.3),并手工检索相关会议论文集及药厂资料等。按纳入与排除标准选择试验、提取资料并评价方法学质量后,采用RevMan 5.0软件对数据进行Meta分析。结果共纳入17个RCT,合计1?281例患者,均为低质量研究。Meta分析结果显示:环磷腺苷葡胺+常规治疗组在升高左室射血分数[5.75,95%CI(3.61,7.89)]、提高每搏输出量[WMD=5.55,95%CI(3.71,7.38)]、提高E/A峰值[WMD=0.09,95%CI(0.05,0.14)]及改善6分钟步行距离[WMD=43.52,95%CI(21.00,66.04)]方面均优于常规治疗组,而在提高心输出量[WMD=0.20,95%CI(–0.31,0.71)]和改善心率[WMD=0.64,95%CI(–7.49,8.77)]方面与常规治疗组比较差异无统计学意义。治疗期间环磷腺苷葡胺组未见明显不良反应或过敏反应的报道。结论现有临床研究表明,环磷腺苷葡胺能有效改善慢性心力衰竭患者的射血分数、每搏输出量、E/A峰值和6分钟步行距离,但由于纳入研究存在选择性偏倚和测量偏倚的高度可能性,势必影响结果的论证强度,因此期待更多高质量的随机双盲对照试验提供更高质量的证据。

Objective To assess the e ectiveness and safety of meglumine adenosine cyclophosphate（MAC） for chronic heart failure.Methods e databases such as Cochrane Central Register of Controlled Trials（Issue 3,2011）,MEDLINE（1950 to March 2011）,EMbase（1980 to March 2011）,CNKI（1995 to March 2011）,and VIP（1989 to March 2011） were searched,and the relevant journals and conference proceedings were also manually retrieved.en the stud-ies were screened according to prede ned inclusion and exclusion criteria,and their quality was evaluated.Meta-analyses were performed by using RevMan 5.0 so ware.Results Seventeen randomized controlled trials（RCTs） involving 1？281 patients were included.All of the included RCTs were Grade C in methodological quality.e results of meta-analyses showed that MAC plus routine treatment was superior to routine treatment in improving the le ventricular ejection frac-tion（WMD=5.75,95%CI 3.61 to 7.89）,stroke volume（SV）（WMD=5.55,95%CI 3.71 to 7.38）,E/A（WMD=0.09,95%CI 0.05 to 0.14） and 6 min walk test（WMD=43.52,95%CI 21.00 to 66.04）.But MAC plus routine treatment was similar to routine treatment in regulating cardiac index（CO）（WMD=0.20,95%CI –0.31 to 0.71） and heart rate（WMD=0.64,95%CI –7.49 to 8.77）.No signi cant adverse e ects or allergic reactions were reported.Conclusion e current evidence shows that MAC may improve the le ventricular ejection fraction,stroke volume,E/A and 6 min walk test.Due to a high risk of selection bias and detection bias in the included studies,the evidence is insu cient to determine the e ectiveness of MCA.Further large-scale trials are required to de ne the role of MAC in the treatment of chronic heart failure.