参附注射液治疗心力衰竭的Meta分析

Meta- analysis on Shenfu Injection in the treatment of heart failure

目的:系统评价参附注射液治疗心力衰竭的临床疗效。方法:计算机检索CNKI、万方数据库、读秀数据库、Pub Med自建库以来至2013年7月公开发表的与参附注射液治疗心力衰竭相关的随机对照试验(RCT),并手工检索相关杂志,经质量评价最终纳入文献后采用Review Manger 5.0软件进行Meta分析。结果:共纳入31个研究,全部为中文,Jadad评分2篇为2分,29篇为1分。Meta分析结果显示,参附注射液组与西药常规治疗组比较:参附注射液可提高临床疗效(RR=1.26,95%CI[1.20,1.32],P<0.00001);增加左室射血分数(WMD=3.67,95%CI[3.31,4.21],P<0.00001);减小左室舒张末内径(WMD=-2.03,95%CI[-2.76,-1.31],P<0.00001);增加6min步行距离(WMD=47.32,95%CI[29.11,65.53],P<0.00001);降低NT-pro BNP水平(WMD=-317.75,95%CI[-347.06,-288.44],P<0.00001);降低BNP水平(WMD=-94.20,95%CI[-101.43,-86.97],P<0.00001)。结论:参附注射液较西药常规治疗心力衰竭可进一步提高临床疗效,对心功能的改善有一定的作用。但由于纳入文章质量有限,样本量较小,需要更多高质量大规模的RCT进一步验证。

Objective： To systematically evaluate the efficacy of Shenfu Injection in the treatment of the heart failure （HF） patients. Methods： A computer search was performed using CNKI, Wanfang, Duxiu and PubMed to identify the randomized controlled trials （RCTs） of Shenfu Injection in the treatment of the heart failure （HF） patients published up to July 2013, and relevant journals were manually searched; the identified studies were finally selected after full-text search and quality assessment and then subjected to meta-analysis using Review Manager 5.0. Results： A total of 31 RCTs were included in the meta-analysis, and all of them were carried in China. Jadad score of 29 studies were 1, 2 studies were 2. The Meta-analysis showed that the Shenfu Injection group had a significantly higher of efficacy than the control group in terms of the clinical efficacy （RR=1.26, 95%CI[1.20, 1.32], P〈0.00001）, increased left ventricular ejection fraction （WMD=3.67, 95%CI[3.31, 4.21], P〈0.00001）, reduced LVSD （WMD=-2.03, 95%CI[-2.76, -1.31], P〈0.00001）, increase the six-minute walking distance （WMD=47.32, 95%CI[29.11, 65.53], P〈0.00001）, reduce the level of NT-proBNP （WMD=-317.75, 95%CI[-347.06, -288.44], P〈0.00001）, and reduce the level ofBNP （WMD=-94.20, 95%CI[-101.43, -86.97], P〈0.00001）. Conclusion： Shenfu Injection can significantly improve the clinical efficacy, but which needs to be further confirmed by more large-sample, high-quality RCTs.