重组人脑利钠肽对中国人群急性心衰患者疗效和安全性的Meta分析

A Meta Analysis on Effectiveness and Safety of Recombinant Human Brain Natriuretic Peptide in Chinese Patients with Acute Heart Failure

目的:评价重组人脑利钠肽(rhBNP)对中国人群急性心衰患者的疗效和安全性,为临床实践和研究提供参考和依据。方法:计算机检索PubMed,Web of Knowledge,VIP,CNKI和万方数据库。手工检索所有纳入文献的相关参考文献,筛选有关rhBNP治疗中国人群急性心衰患者的随机对照试验,在符合纳入与排除标准的文献中提取数据,采用RevMan5.2版软件进行Meta分析。结果:纳入20篇文献,包括1 739名患者,其中rhBNP组(实验组)865例,常规治疗组(对照组)874例。Meta分析结果显示:提高左室射血分数rhBNP组优于对照组(WMD=7.82,95%CI:7.04-8.60)、降低左室舒张末期容积rhBNP组优于对照组(WMD=-1.54,95%CI:-2.41--0.66)、降低NT-proBNP水平比较rhBNP组优于常规治疗组(WMD=-839.75,95%CI:-1 264.87--414.62)、心功能改善有效率rhBNP组优于对照组(OR=4.42,95%CI:3.25-6.02)、不良反应发生率rhBNP组与对照组相比差异无统计学意义(OR=0.63,95%CI:0.38-1.06)。发表偏倚及敏感性分析提示纳入的研究无明显发表偏倚,稳定性较好。结论:与常规治疗相比,rhBNP对于中国人群急性心衰患者的心功能等级与预后均有明显的改善作用,且无明显不良反应。

Objective：To evaluate the effectiveness and safety of recombinant human brain natriuretic peptide（rhBNP）in Chinese patients with acute heart failure,and to provide reference and evidence for clinical practice and research.Methods：We searched the randomized controlled trials about the rhBNP for Chinese patients with acute heart failure in Pubmed,Web of Knowledge,VIP,CNKI and Wanfang Data.Manual retrieval of all relevant literature references was also included,and studies were selected based on inclusion for exclusion criterion and extracting data and information.The data and information were used to perform Meta-analysis by Revman 5.2.Results：Twenty RCTs were included.A total of 1 739 patients were included in the analysis,ofwhich 865 patients were in the rhBNP treatment group（study group）and 874 patients were in the conventional treatment group（control group）.By Meta-analysis,compared with conventional treatment,rhBNP treatment had a significant benefit in the LVEF（WMD=7.82,95%CI：7.04-8.60）,LVDD（WMD=-1.54,95%CI：-2.41--0.66）,NT-proBNP（WMD=-839.75,95%CI：-1264.87--414.62）and the level of improvement in cardiac function（OR=4.42,95%CI：3.25-6.02）.The incidence of side effects was similar in the two groups（OR=0.63,95%CI：0.38-1.06）.No significant publication bias was found and the results of sensitivity analysis were also relatively consistent with above findings.Conclusion：Compared with conventional treatment,rhBNP treatment can effectively improve the level of cardiac function and prognosis and the incidence of side effects was similar.