新活素治疗急性心肌梗死合并心力衰竭的疗效及安全性Meta分析

Meta-analysis of the efficacy and safety of rhbnp in the treatment of acute myocardial infarction with heart failure

目的:系统评价新活素对急性心肌梗死合并心力衰竭的疗效及安全性。方法:计算机检索中国知网(CNKI)、万方数据库(Wan Fang)、维普中文科技期刊数据库(VIP)、中国生物医学文献数据库(CBM)、Medline、Cochrane Library、Clinical Trail.Gov收集从建库至2019年12月关于新活素治疗急性心肌梗死合并心力衰竭的临床随机对照试验(RCT),依据Jadad量表、疾病的纳入和排除标准提取数据,采用RevMan 5.3软件进行Meta分析。结果:共纳入23个RCT,共2024例患者,其中对照组1012例(西医常规治疗),试验组1012例(在对照组基础上+新活素治疗)。Meta分析结果显示:在总有效率方面,试验组优于对照组,差异有统计学意义[OR=4.30,95%CI(3.26,5.67),P<0.00001];在左室射血分数方面,试验组优于对照组,差异有统计学意义[OR=1.58,95%CI(1.27,1.90),P<0.00001];在左心室舒张末期内径方面,试验组优于对照组,差异有统计学意义[OR=-0.91,95%CI(-1.50,-0.33),P=0.002];在心搏出量方面,试验组优于对照组,差异有统计学意义[OR=1.24,95%CI(0.55,1.94),P=0.0005];在脑钠肽前体方面,试验组优于对照组,差异有统计学意义[OR=-4.37,95%CI(-6.21,-3.25),P<0.00001];在心率方面,试验组优于对照组,差异有统计学意义[OR=-13.70,95%CI(-14.95,-12.46),P<0.00001];在收缩压方面,试验组优于对照组,差异有统计学意义[OR=-12.38,95%CI(-17.98,-6.79),P<0.00001];在舒张压方面,试验组优于对照组,差异有统计学意义[OR=-7.42,95%CI(-8.53,-6.30),P<0.00001];在不良反应方面,差异无统计学意义[OR=0.95,95%CI(0.29,3.16),P=0.94]。结论:在急性心肌梗死合并心力衰竭的患者中,及时应用新活素治疗可提高临床疗效,改善心功能,抑制心室重构,改善血压及心率,具有较好的临床疗效及安全性。

Objective:Systematic review of the efficacy and safety of neoactivin re-acute myocardial infarction with heart failure.Methods:Databases including CNKI,Wan Fang,Weipu Chinese Science and Technology Periodicals Database(VIP),China Biomedical Literature Database(CBM),Medline,Cochrane Library,and Clinical Trail were retrieved.Gov collected clinical randomized controlled trials(RCTs)of neoactivin in the treatment of acute myocardial infarction with heart failure from the establishment of the database to December 2019.Data were extracted according to the Jadad scale,disease inclusion and exclusion criteria,and RevMan 5.3 software was used for Meta analysis.Results:A total of 23 RCTs were included,with a total of 2024 patients,including 1012 patients in the control group(conventional treatment with western medicine)and 1012 patients in the test group(on the basis of the control group+neoactivin treatment).Meta analysis results show that in terms of the total effective rate,the test group is better than the control group,and the difference is statistically significant[OR=4.30,95%CI(3.26,5.67),P<0.00001];in terms of left ventricular ejection fraction,the test group was better than the control group,and the difference was statistically significant[OR=1.58,95%CI(1.27,1.90),P<0.00001].In terms of the left ventricular end-diastolic diameter,the test group was better than the control group,with a statistical difference significance[OR=-0.91,95%CI(-1.50,-0.33),P=0.002];in terms of stroke volume,the test group was better than the control group,and the difference was statistically significant[OR=1.24,95%CI(0.55,1.94),P=0.0005];in terms of brain natriuretic peptide precursors,the experimental group was better than the control group,the difference was statistically significant[OR=-4.37,95%CI(-6.21,-3.25),P<0.00001];In terms of heart rate,the test group is better than the control group,and the difference is statistically significant[OR=-13.70,95%CI(-14.95,-12.46),P<0.00001];in terms of systolic blood pressure,the test group is better than the control Group,the difference was statistically significant[OR=-12.38,95%CI(-17.98,-6.79),P<0.00001];in diastolic blood pressure,the test group was better than the control group,the difference was statistically significant[OR=-7.42,95%CI(-8.53,-6.30),P<0.00001];in terms of adverse reactions,the difference was not statistically significant[OR=0.95,95%CI(0.29,3.16),P=0.94].Conclusions:In patients with acute myocardial infarction and heart failure,the timely application of neoactivin treatment,which has good clinical efficacy and safety,can improve clinical efficacy,improve cardiac function,inhibit ventricular remodeling,improve positively regulate blood pressure and heart rate.