左西孟旦和米力农治疗心衰的有效性和安全性的Meta分析

The clinical effect and security of Levosimendan and Milrinone on patients with heart failure： A meta-analysis

目的 对比分析左西孟旦和米力农治疗心衰的有效性和安全性.方法 互联网检索PUBMED、Cochrane图书馆和万方、知网、维普中文电子库资源,收集米力农和左西孟旦治疗心力衰竭的随机对照临床研究.结果 共有20篇文献,患者总数1584人.Meta分析结果表明,与米力农治疗心衰相比,左西孟旦可明显提高患者的临床疗效（OR =0.22,95％ CI 0.18～0.26,P＜0.01）,心衰标志物BNP和NT-proBNP也明显减少（MD=209.04,95％ CI 137.03～281.05,P＜0.01;MD=306.44,95％ CI 261.58～351.30,P＜0.01）.彩超提示心功能明显升高：左室射血分数（LVEF）、每搏输出量（SV）、心脏指数（CI）均明显提高（MD=5.69,95％CI4.45～6.93,P＜0.01;MD=511.34,95％CI 7.56～15.11,P＜0.01;MD=0.23,95％CI 0.11～0.34,P=0.00001）,而左室舒张末期容积（LVEDD）及E/A比值无明显提高（MD=1.84,95％CI-0.06～3.75,P=0.06;MD =0.01,95％CI-0.06～0.08,P=-0.82）.不良反应如低血压、心律失常的发生率未见统计学差异（MD=1.69,95％CI 0.95～3.01,P=0.07;MD=0.38,95％CI 0.14～0.99,P=0.05）.结论 左西孟旦较米力农可提高心衰患者的临床疗效,增加患者的心脏泵血功能,改善患者的临床症状,且不良反应发生率低,但对舒张功能可能效果不显著.鉴于文章质量有限,结果有待进一步的研究.

Objective To analyze the function of Levosimendan and Milrinone on patients with heart failure. Methods The relevant randomized controlled trials （RCTs） about Levosimendau versus Milrinone on pa- tients with heart failure were searched online medical databases and collected. Results As much as 20 studies were collected in our study. As for the Milrinone, the Levosimendan group has a better curative effect on the re- duction of clinical symptom （OR =0.22,95%CI 0.18-0.26,P〈0.01 ）, the severity parameter of heart failure BNP and NT-proBNP were also decreased （MD=209.04,95%CI 137.03-281.05,P〈0.01 ,MD=306.44,95%CI 261.58- 351.30,P〈0.01）, the heart function such as LVEF, SV, CI had increased（MD=5.69,95%Cl 4.45-6.93,P〈0.01, MD=511.34,95%CI 7.56-15.11 ,P〈0.01 ,MD=0.23,95%CI 0.11-0.34,P=0.00001 ）. However, there were not significant difference about LVDD and E/A value （MD=1.84,95%CI -0.06-3.75,P=0.06,MD=0.01,95%CI - 0.06-0.08,P=0.82）. As for the adverse effect, there were no significant occurrence on the low blood pressure and arrhythmia （MD=1.69,95%CI 0.95-3.01,P=0.07,MD=0.38,95%CI 0.14-0.99,P=0.05）. Conclusion Levosi-mendan has a better effect on the patients with heart failure and help improve the heart systolic function with few adverse effect, but may do not alleviate diastolic disfunction. Owing to the quality and quantity of the studies, the conclusion is still should be proved with more researches.