五苓散加减治疗慢性心力衰竭的Meta分析

Meta-analysis of clinical efficay of modified wulingsan decoction in the treatment of chronic heart failure

目的:系统评价五苓散加减治疗慢性心衰的临床有效性和安全性。方法:电子检索中国知网(CNKI)、维普数据库(VIP)、万方数据库(WANFANG-DATA)、Pub Med等数据库,检索时间为数据库建立至2019年12月,检索数据库收录的五苓散加减治疗慢性心力衰竭的临床随机对照实验(RCT)文献。两名评价者独立检索、筛选、纳入符合标准的文献,提取文献有效数据资料,应用Jadad评分标准评价研究的方法学质量,并采用Revman 5.3软件对数据进行统计分析。结果:按照标准纳入19篇文献,共纳入1970例慢性心衰患者,治疗组994例,对照组976例。Meta分析结果:①在改善临床疗效方面,治疗组明显优于对照组(RR=1.21,95%CI=[1.16,1.26],Z=9.57,P<0.00001);②提高左室射血分数方面,治疗组明显优于对照组(WMD=5.55,95%CI=[3.95,7.14],Z=6.82,P<0.00001);③降低血清NT-pro-BNP方面,治疗组明显优于对照组(WMD=-195.75,95%CI=[-227.36,-164.13],Z=12.14,P<0.00001)。结论:五苓散加减治疗慢性心力衰竭对于改善临床疗效、提高左室射血分数、降低血清NT-pro-BNP均有良好的效果,但是纳入文献质量偏低,存在发表偏倚等问题,本文章结论尚需要一些高质量的随机对照临床试验支持。

Objective:To systematically review the efficacy and the safety of modified Wulingsan decoction for treating acute exacerbation patients with Chronic Heart Failure(CHF).Methods:Computer retrieval databases CNKI,VIP,WANFANG-DATA and Pub Med were established until December 2019.The clinical randomized controlled trials(RCT)of Chronic Heart Failure treated by the modified Wulingsan decoction were studyed.Two researchers independently searched,screened and included the literatures that met the standards,and extracted the effective data of the literatures.Researchers evaluated the methodological quality of the research by Jadad scoring standards,and made statistical analysis of the relevant data by Revman 5.3 software.Results:according to the standard,19 articles were included in 1970 cases of chronic heart failure,including 994 cases in the treatment group and 976 cases in the control group.Meta analysis results:①in improving clinical efficacy,the treatment group was significantly better than the control group,(RR=1.21,95%CI=[1.16,1.26],Z=9.57,P<0.00001);②in improving left ventricular ejection fraction,the treatment group was significantly better than the control group,(WMD=5.55,95%CI=[3.95,7.14],Z=6.82,P<0.00001);③in reducing serum NT Pro BNP,the treatment group was significantly better than the control group(WMD=-195.75,95%CI=[-227.36,-164.13],Z=12.14,P<0.00001).Conclusion:Modifided Wulingsan decoction treatment for chronic heart failure has good effect on improving clinical efficacy,increasing left ventricular ejection fraction and reducing serum NT Pro BNP,but the quality of the included literatures is low,and there are some problems such as publication bias.The conclusion of this article needs some high-quality randomized controlled trials to support.