西地那非对慢性心力衰竭患者治疗效果及安全性的Meta分析

Effects and safety of Sildenafil in patients with systolic heart failure-Meta analysis

目的 评价磷酸二酯酶抑制剂西地那非治疗慢性充血性心力衰竭的效果及安全性.方法 通过检索Pubmed、EMBASE、Cochrane、中国生物医学文献数据库、中文期刊文献数据库、万方数据库文献,手工检索已纳入相关的参考文献.纳入西地那非与安慰剂对照、治疗周期超过4周、左室射血分数降低的随机对照研究,经质量评估、数据提取,进行Meta分析.结果 纳入7项随机对照研究,共计315例观察对象,301例完成超过4周随访,其中治疗组153例、对照组148例.分析结果显示,治疗组左室射血分数[均数差=3.75,95％可信区间1.43～6.06,P＜0.01]和峰值氧耗量[均数差=2.92,95％可信区间为1.48～4.36,P＜0.01]增加,二氧化碳通气当量斜率降低[均数差=-5.93,95％可信区间为-7.19～-4.67,P＜0.01],肺动脉收缩压[均数差=-12.97,95％可信区间为-17.42～-8.51,P＜0.01]、肺动脉平均压[均数差=-6.21,95％可信区间为-12.08～-0.34,P＜0.05]、肺毛细血管口压[均数差分别为-3.57 （P＜0.01）和-89.96（P＜0.01）,95％可信区间分别为-6.12～.1.01和-121.50～-58.42]和肺循环阻力[均数差=-89.96,可信区间为-121.50～-58.42,P＜0.01]均明显降低.西地那非对右房压和周围血管阻力无明显影响,对慢性心力衰竭生活质量评估积分无明显影响.治疗中患者血压、心率平稳,无心律失常;主要副作用为头痛.结论 慢性心力衰竭患者选择性使用西地那非可以明显改善心肺功能,无明显副作用,长期使用患者有良好的耐受性.

Objective Our study aimed to assess the efficacy and safety of phosphodiesterase type 5 inhibitor （PDE5） Sildenafil in the patients with systolic heart failure.Methods We performed a systemic searched and identified in the Pubmed,EMBASE,Cochrane and CBM databases to collected Randomized controlled trials （RCT） study.The reference literature was retrieved manually.Prospective RCT of Sidenfil with duration at least 4 weeks and treatment VS placebo and LVEF reduce were included.After quality assessments and data extraction all study were given meta-analysis.Results We enrolled 7 RCT study total 315 patients.301 patients were followed over 4 weeks （Sildenafil 153,placebo 148）.Sildenafil showed benefits in increasing LVEF （MD=3.75,95%CI 1.43-6.06,P〈0.01） and Peak VO2 （MD=2.92,95%CI 1.48-4.36,P〈0.01） and reducing VE/VCO2 （MD=-5.93,95%CI-7.19--4.67,P〈0.01）and mean pulmonary pressure （MD=-6.21,95%CI-12.08--0.34,P〈0.05） and pulmonary capillary wedge pressure （MD=-3.57,95%CI-6.12--1.01） and pulmonary vascular resistance （MD=-89.96,95%CI-121.50--58.42,P〈0.01）.There was no significantly difference in blood pressure and heart rate and arrhythmia and quality of life between tow groups.The mainly adverse was headache.Conclusion Sildenafil was curative effects in improvement function of heart.The select use was safety and well tolerated.