五苓散治疗慢性心力衰竭的系统评价

A meta-analysis of clinical efficacy on Wuling San treatment for chronic heart failure

目的系统评价五苓散治疗慢性心力衰竭(chronic heart failure, CHF)的临床疗效。方法计算机检索中国期刊全文数据库(CNKI)、中国生物医学文献服务系统(SinoMed)、中国学术期刊数据库(万方数据)、中文科技期刊数据库(重庆维普)、Cochrane Library、PubMed数据库、Embase各库建库至2017年10月有关五苓散治疗CHF的RCT,对纳入文献采用GRADE profiler 3.6.1软件进行证据质量评估,采用Egger试验评估发表偏倚情况,采用Review Manager 5.2及stata 14.0软件进行meta分析。结果共纳入文献15篇,受试者1 160例。Meta分析结果提示,治疗组的心功能疗效总有效率高于对照组[OR=4.60,95% CI(3.12~6.77),Z=7.72,P<0.01];治疗前后左心室射血分数(left ventricular ejection fractions, LVEF)由于存在异质性,故将纳入研究按疗程进一步分为疗程≤4周与疗程>4周2组,并进行亚组分析,2组中治疗组均优于对照组[WMD=9.53,95% CI(8.80~10.28),Z=25.63,P<0.01];治疗前后B型脑钠肽(B-type natriuretic peptide, BNP)治疗组优于对照组[WMD=-65.52,95% CI(-88.45^-48.59),Z=6.74,P<0.01]。结论在常规西药治疗基础上加用五苓散治疗CHF疗效更好。但受纳入研究质量所限,仍需更多高质量研究予以验证。

Objective To evaluate the clinical efficacy of Wuling San in the treatment of Chronic heart failure by meta analysis. Methods The randomized controlled trials were searched from CNKI, Wanfang Data, VIP Data, CBM Data, Cochrance Library, PubMed, EMbase. Review 5.2 Manager software, stata 14.0 software, GRADE profiler 3.6.1 software were used to bias risk assessment, meta analysis, and quality evaluation of the studies. Results Fifteen studies with 1 160 patients were included. The overall quality of studies is low. The meta analysis results showed that the total efficiency of improving heart function in the treatment group were superior to the control group [OR=4.60, 95% CI (3.12, 6.77), Z=7.72, P<0.01]. Due to the heterogeneity, the studies of left ventricular ejection fraction (LVEF) were divided into two subgroups according to the course of treatment, one group with more 4 weeks course treatment and the other group with less 4 weeks. The LVEF in the treatment group was superior to the control group [WMD=9.53, 95% CI (8.80, 10.28), Z=25.63, P<0.01]. The brain natriuretic peptide (BNP) iin the treatment group was superior to the control group [WMD=-65.52, 95% CI (-88.45, -48.59), Z=6.74, P<0.01]. Conclusions The present meta-analysis suggests that combination of conventional western medicine and Wuling San has better effect on heart failure. Due to the poor quality of included RCTs, the conclusions may exist bias. Thus, more RCTs with high quality are needed.