芪苈强心胶囊联用曲美他嗪治疗慢性心力衰竭的荟萃分析

Meta analysis of Qiliqiangxin capsule combined with trimexazidine in the treatment of chronic heart failure

目的:系统评价芪苈强心胶囊联用曲美他嗪治疗慢性心力衰竭的临床疗效和安全性,为临床推广提供理论依据。方法:检索PubMed、Medline、中国期刊全文数据库(中国知网,CNKI)、维普科技期刊数据库(VIP)、万方数据-数字化期刊群数据库,收集在常规治疗基础上加用芪苈强心胶囊联用曲美他嗪治疗慢性心力衰竭的随机、对照研究,检索年限为1990年1月至2016年8月。采用Rev Man 5.2软件进行荟萃(Meta)分析。结果:共纳入12项研究,1030例病人。荟萃分析结果显示,相对于常规治疗或单用曲美他嗪,芪苈强心胶囊联用曲美他嗪显著提高临床疗效[RR=1.25,95%CI(1.18,1.32),P<0.00];增加左室射血分数(LVEF)[MD=6.33,95%CI(5.04,7.63),P<0.01];二尖瓣血流最大流速E峰与A峰比值(E/A)[MD=0.23,95%CI(0.14,0.33),P<0.00];显著降低前体N末端前脑利钠肽(NT-pro BNP)[MD=-278.65,95%CI(-427.63,-129.67),P<0.00],同时显著增加6 min步行距离(6MWD)[MD=35.28,95%CI(17.52,53.04),P<0.00]。未见明显药品不良反应。结论:芪苈强心胶囊联用曲美他嗪治疗慢性心力衰竭疗效明显,左室射血分数、前体N末端前脑利钠肽和6min步行距离改善显著,且安全性好,值得临床推广。

Objective：To systematically review the efficacy and safety of Qiliqiangxin（QLQX）capsule combined with trimexazidine in the treatment of chronic heart failure（CHF）so as to provide theoretical basis of clinical promotion.Methods：Literature of randomized controlled trials about the treatment of CHF with QLQX capsule combined with trimexazidine on the basis of routine treatment were retrieved from the databases of PubMed,Medline,the databases of China National Knowledge Infrastructure（CNKI）,the VIP China Science and Technology Journal Database,Wanfang Data-Digitalization Journals from January 1990 to August 2016.Then meta-analysis was performed with Rev Man 5.2 software.Results：A total of 12 papers involving 1030 patients were included in the study.Meta-analysis showed that as compared with conventional therapy or simple trimexazidine,treatment with QLQX capsule combined with trimexazidine in the CHF patients could significantly improve clinical efficacy[RR=1.25,95%CI（1.18,1.32）,P〈0.00],increased left ventricular ejection fraction（LVEF）[MD=6.33,95%CI（5.04,7.63）,P〈0.00]and E peak and A peak ratio（E/A）of mitral flow velocity[MD=0.23,95%CI（0.14,0.33）,P〈0.00],reduced pre N terminal pro brain natriuretic peptide（NT-pro BNP）[MD=-278.65,95%CI（-427.63,-129.67）,P〈0.00],and meanwhile increased 6-minute walking distance（6 MWD）[MD=35.28,95%CI（17.52,53.04）,P〈0.00].There were no obvious adverse drug reactions.Conclusion：Evidences showed that QLQX capsule combined with trimexazidine could produce significant therapeutic effects on CHF and improve LVEF,NT-pro BNP and 6-minute walking distance,with good safety.For this reason,it is worth further clinical extension.