真武汤加减治疗慢性心衰临床疗效的系统评价及试验序贯分析

Systematic Review and Sequential Analysis on Clinical Efficacy of Modified Zhenwu Decoction in Treating Chronic Heart Failure

目的:评价真武汤加减治疗慢性心衰的有效性。方法:检索中国知网(CNKI)、万方数据库、维普数据库,外文数据库 Pubmed、 Corchrane 图书馆数据库等筛选出真武汤加减治疗慢性心衰的研究。以"真武汤"与"慢性心力衰竭""心力衰竭""心衰""心功能不全"分别组合为关键词,检索期限为2010 年1月1日—10月31日,最终筛选出19篇随机对照试验(randomized controlled trials,RCTs)文献。根据Cochrane Handbook提供的方法,用Revman5.3对纳入的19篇文献进行质量评价,采用Stata15.1软件对数据进行合并分析,用TSA0.9软件对有效率进行序贯分析。结果:纳入19项研究1832例患者,纳入研究的质量偏低。Meta分析结果显示,真武汤加减联合西药治疗可更有效的提高慢性心衰患者左心室射血分数;更大程度缩小左心室舒张末期内径;真武汤加减联合西药治疗还可以更好的降低血浆NT-proBNP,并改善6min步行试验;在提高试验组有效率方面高于对照组,差异均有统计学意义。结论:真武汤加减联合西药常规治疗慢性心力衰竭,在提高左心室射血分数、减少左心室舒张末期内径、降低血浆NT-proBNP、延长6 min步行试验和提高总有效率方面优于常规西药治疗。序贯分析显示总有效率累积纳入的研究穿过了TSA界值和传统界值,进一步肯定了其临床疗效。

Objective:To evaluate the effectiveness of Zhenwu Decoction in the treatment of chronic heart failure.Methods:Search the China National Knowledge Network (CNKI),Wanfang database,Weipu database,foreign language database Pubmed,Corchrane library database,etc.to screen out the research of Zhenwu Decoction for treatment of chronic heart failure.Take “Zhenwu Decoction” and “Chronic Heart Failure”,“Heart Failure”,“Heart Failure” and “Heart Insufficiency” as keywords respectively.The search period is from January 1st to October 31st,2010,and 19 articles were finally screened out.Randomized controlled trials (RCTs) literature.According to the method provided by the Cochrane Handbook,Revman5.3 was used to evaluate the quality of the included 19 articles,Stata 15.1 software was used to merge and analyze the data,and TSA0.9 software was used to perform sequential analysis of the efficiency.Results:19 studies with 1832 patients were included,and the quality of the included studies was low.Meta analysis results show that Zhenwu Decoction combined with Western medicine treatment can more effectively increase the left ventricular ejection fraction in patients with chronic heart failure;reduce the left ventricular end-diastolic diameter to a greater extent;Zhenwu Decoction combined with Western medicine treatment can also better reduce plasma NT-proBNP,and improve the 6-minute walk test;it is higher than the control group in improving the effective rate of the test group,and the difference is statistically significant.Conclusion:Modified Zhenwu Decoction combined with western medicine in conventional treatment of chronic heart failure is superior to conventional western medicine in improving left ventricular ejection fraction,reducing left ventricular end-diastolic diameter,reducing plasma NT pro-BNP,prolonging the 6-minute walk test,and improving total effective rate.Sequential analysis showed that the cumulative total effective rate of the included studies crossed the TSA threshold and the traditional threshold,further confirming its clinical efficacy.