左西孟旦与米力农治疗心力衰竭疗效比较Meta分析

Clinical Effect of Levosimendan and Milrinone for Treating Heart Failure: a Meta-Analysis

目的比较左西孟旦与米力农治疗心力衰竭的疗效与安全性。方法计算机检索中国知网(CNKI)全文数据库、万方数据库、维普(VIP)中文科技期刊数据库、PubMed,收集建库至2016年11月公开发表的有关左西孟旦与米力农治疗心力衰竭的疗效与安全性比较的随机对照试验(RCT),同时辅以手检纳入文献的参考文献。在严格质量评价的基础上,对符合入选要求的临床研究进行资料提取,数据采用RevMan 5.3软件进行Meta分析。结果纳入9篇研究,共713例患者;Meta分析结果显示,与米力农组相比,左西孟旦组总有效率[RR=1.35,95%CI(1.23,1.49),P<0.000 01]更高,左心室射血分数[LVEF,SMD=0.64,95%CI(0.17,1.11),P=0.008]、心脏指数[CI,SMD=0.55,95%CI(0.26,0.83),P=0.000 1]显著升高,B型脑钠肽[BNP,SMD=-1.02,95%CI(-1.28,-0.76),P=0.000 01]显著降低;左西孟旦组3个月再住院率[RR=0.57,95%CI(0.35,0.91),P=0.02]明显低于米力农组;两组不良反应发生率无明显差异[RR=0.75,95%CI(0.50,1.15),P=0.19]。结论左西孟旦治疗心力衰竭的效果明显优于米力农,且3个月再住院率更低,两者安全性均较好。但本研究尚有不足,仍需更多试验进一步验证左西孟旦治疗心力衰竭的临床疗效。

Objective To compare the clinical effect and safety of levosimendan and milrinon in the treatment of heart failure.Methods The dababases of CNKI,Wan Fang Data,VIP and PubMed were retrieved with computer for collecting the RCTs about comparison in curative effect and safety of levosimendan and milrinone in the treatment of heart failure from the date of estabishment of the databases to November 2016,and the literatures supplemented manually for searching reference were included. After rigorous evaluating on quality,the data were extracted from eligible clinical studies and given a Meta-analysis by using RevMan 5. 3 software.Results There were 9 studies included,involving 713 patients. The results of Meta-analysis showed that： compared with the milrinone group,the total effective rate in the levosimendan group was higher [ RR = 1. 35,95% CI（ 1. 23,1. 49）,P 0. 000 01 ],the left ventricu lar ejection fraction [ LVEF, SMD = 0. 64,95 % CI（ 0. 17,1. 11）,P = 0. 008 ] and cardiac index [ CI,SMD = 0. 55,95 % CI（ 0. 26,0. 83）,P = 0. 000 1] were significantly increased,B-type brain natriuretic peptide[BNP,SMD =-1. 02,95% CI（-1. 28,-0. 76）,P = 0. 000 01 ]was significantly reduced,the 3-month rehospitalization rate in the levosimendan group [ RR = 0. 57,95% CI（ 0. 35,0. 91）,P = 0. 02 ]was sig nificantly lower than that in the milrinone group. There was no significant difference in the incidence of adverse reactions between the two groups [ RR = 0. 75,95% CI（ 0. 50,1. 15）,P = 0. 19 ]. Conclusion The curative effects of levosimendan is superior to that of milrinone in treatment of heart failure,and the 3-month rehospitalization rate was lower,both of them have good safety.However,there are still shortcomings in this study,more tests are needed to further verify the clinical efficacy of levosimendan in the treatment of heart failure.