补气活血利水中药治疗慢性心力衰竭有效性及安全性的Meta分析

Clinical Efficacy and Safety of Traditional Chinese Medicine for Tonifying Qi,Activating Blood Circulation and Promoting Diuresis in the Treatment of Chronic Heart Failure:a Meta-analysis

目的系统评价补气活血利水中药治疗慢性心力衰竭的有效性和安全性。方法通过计算机检索中国期刊全文数据库(CNKI)、中文科技期刊全文数据库(VIP)、万方知识服务平台、EMbase、PubMed、MedLine等,检索时间设为各数据库建库之日起至2019年8月。对所选文献严格按照纳入与排除标准进行筛选及质量评价,并运用RevMan 5.3软件对所纳入的随机对照试验(RCT)进行Meta分析。结果对检索到的1846篇文献经筛选后,最终纳入32项研究,总计包括3188例病人。Meta分析结果表明:试验组临床疗效总有效率高于对照组[OR=3.61,95%CI(2.78,4.68),P<0.00001],左室射血分数提高程度优于对照组[MD=5.87,95%CI(4.43,7.31),P<0.00001],血浆N-末端脑利钠肽前体降低程度优于对照组[MD=-231.28,95%CI(-308.56,-154.00),P<0.00001],6 min步行试验改善程度优于对照组[MD=64.18,95%CI(39.57,88.80),P<0.00001],左室舒张末期内径改善程度优于对照组[MD=-3.98,95%CI(-5.40,-2.56),P<0.00001],二尖瓣血流速度峰值比增加程度优于对照组[MD=0.26,95%CI(0.12,0.40),P=0.0004]。结论现有研究证据表明:补气活血利水中药联合西药治疗慢性心力衰竭,可明显改善临床疗效,提高左室射血分数,降低血浆N-末端脑利钠肽前体水平,增加6 min步行距离,改善左室舒张末期内径,增加二尖瓣血流速度峰值比。但本研究所纳入文献总体质量偏低,并且部分文献存在方法学问题,导致临床治疗证据不够充分。

Objective To systematically evaluate the Clinical efficacy and safety of traditional Chinese medicine for tonifying qi,activating blood circulation and promoting diuresis in the treatment of chronic heart failure.Methods China Journal Full-Text Database(CNKI),Chinese science and technology periodical database(VIP),Wanfang database,EMbase,PubMed,and MedLine were searched by computer from the date of the establishment of each database to August 2019.The literatures were screened and evaluated strictly according to the inclusion and exclusion criteria,and the study results of the included literatures were analyzed by Rev Man 5.3.Results After screening the 1846 pupers were retrieved,32 literatures were included,including 3188 patients.The results of Meta analysis showed that the clinical efficacy of the experimental group was higher than that of the control group[OR=3.61,95%CI(2.78,4.68),P<0.00001],the improvement of left ventricular ejection fraction in the experimental group was better than that in the control group[MD=5.87,95%CI(4.43,7.31),P<0.00001],and the decrease of N-terminal pro-brain natriuretic peptide in the experimental group was better than that in the control group[MD=-231.28,95%CI(-308.56,-154.00),P<0.00001],the improvement degree of 6-minute walking test in the experimental group was better than that in the control group[MD=64.18,95%CI(39.57,88.80),P<0.00001],the improvement of left ventricular end-diastolic diameter in the experimental group was better than that in the control group[MD=-3.98,95%CI(-5.40,-2.56),P<0.00001],and the peak ratio of mitral flow velocity in the experimental group was better than that in the control group[MD=0.26,95%CI(0.12,0.40),P=0.0004].Conclusion Current evidence showed that traditional Chinese medicine for tonifying qi,activating blood circulation and promoting diuresis combined with western medicine in the treatment of chronic heart failure could significantly improve the clinical efficacy,increase the left ventricular ejection fraction,decrease the level of N-terminal pro-brain natriuretic peptide,increase the 6-minute walking distance,improve the left ventricular end-diastolic diameter and the peak ratio of mitral flow velocity.The overall quality of literatures was low,there was some metholologiend problens in some literature,resulting in insufficient evidence for clinical treatment.