左西孟旦联合重组人脑利钠肽治疗急性心力衰竭疗效和安全性的Meta分析

Efficacy and Safety of Levosimendan Combined with Recombinant Human Brain Natriuretic Peptide in the Treatment of Acute Heart Failure:a Meta-analysis

目的系统评价左西孟旦联合重组人脑利钠肽治疗急性心力衰竭(AHF)的疗效和安全性。方法计算机检索PubMed、EMbase、Cochrane Library、维普数据库、万方数据库、中国知网(CNKI),收集左西孟旦联合重组人脑利钠肽治疗急性心力衰竭的随机对照试验(RCT),检索时间从建库至2020年2月1日,采用Cochrane风险偏倚评估工具评价文献质量,应用RevMan 5.3对文献进行Meta分析。结果最终纳入12篇文献,共计936例病人,Meta结果显示:左西孟旦联合重组人脑利钠肽能够改善急性心力衰竭病人总有效率[RR=1.20,95%CI(1.13,1.28),P<0.00001]、射血分数[MD=5.16,95%CI(3.94,6.38),P<0.00001]、B型钠尿肽[SMD=-4.32,95%CI(-5.99,-2.65),P<0.00001],在不良反应方面比较差异无统计学意义(P>0.05)。结论现有证据表明,与常规治疗相比,左西孟旦联合重组人脑利钠肽可有效改善急性心力衰竭病人临床症状,提高射血分数,降低B型钠尿肽水平,改善心功能,提高生活质量。

Objective To systematically evaluate the efficacy and safety of levosimendan combined with recombinant human brain natriuretic peptide in the treatment of acute heart failure(AHF).Methods PubMed,EMbase,Cochrane Library,Chinese science and technology periodical database(VIP),Wanfang database,China Journal Full-Text Database(CNKI)for randomized controlled trials in patients with coronary heart disease treated with levosimendan combined with recombinant human brain natriuretic peptide were searched from the establishment of each database to February 1,2020.The literature quality was evaluated by the Cochrane risk bias assessment tool,and the literatures of Meta-analysis were used by RevMan 5.3 software.Results A total of 12 literatures were included,involving 936 patients.The result of Meta-analysis showed that levosimendan combined with recombinant human brain natriuretic peptide could significantly improve the the clinical efficacy of patients with acute heart failure[RR=1.20,95%CI(1.13,1.28),P<0.00001],left ventricular ejection fraction[MD=5.16,95%CI(3.94,6.38),P<0.00001],B-type natriuretic peptide[SMD=-4.32,95%CI(-5.99,-2.65),P<0.00001],There was no significant difference in adverse reactions(P>0.05).Conclusion Current evidence showed that compared with conventional treatment,levosimendan combined with recombinant human brain natriuretic peptide could effectively improve the clinical symptoms of patients with acute heart failure,increase the ejection fraction,reduce the level of B-type natriuretic peptide,improve heart function and the quality of life.