参附注射液治疗脓毒症心肌损伤临床疗效的Meta分析

Efficacy and Safety of Shenfu Injection for Sepsis-related Myocardial Injury:A Systematic Review and Meta-analysis

目的评价参附注射液治疗成人脓毒症心肌损伤的临床疗效。方法由2名研究人员独立计算机检索中国知网(CNKI)、万方电子资源网、维普中文科技期刊全文数据库(VIP)、PubMed数据库,收集参附注射液联合西药常规治疗(治疗组)对比单用西药常规治疗(对照组)对脓毒症心肌损伤疗效的随机对照试验(RCT)。对符合纳入标准的临床研究进行资料提取后,运用Jadad量表对纳入文献进行评价,采用RevMan5.3软件进行Meta分析。结果最终纳入10篇文献,共684例患者,其中治疗组349例,对照组335例。纳入研究Jadad评分均为3分。Meta分析结果显示,与西药常规治疗相比,参附注射液有助于降低脓毒症心肌损伤心肌钙蛋白I的水平[SMD=-1.45,95%CI(-210,-0.79),P<0.0001]、肌酸激酶同工酶的水平[SMD=-0.72,95%CI(-1.15,-0.29),P=0.001],以及B型脑利钠肽的水平[SMD=-2.43,95%CI(-3.60,-1.26),P<0.0001]和N-末端前体脑钠肽的水平[SMD=-2.31,95%CI(-3.72,-0.91),P=0.001],改善脓毒症心肌损伤左室射血分数[SMD=1.67,95%CI(0.36,2.98),P=0.01]及心指数[SMD=1.21,95%CI(0.42,1.99),P=0.003]。结论在常规治疗的基础上联合参附注射液能降低脓毒症心肌损伤、改善脓毒症患者心功能障碍。

Objective:To systematically evaluate the clinical efficacy of Shenfu Injection on sepsis-related myocardial injury.Methods:Databases such as CNKI,VIP,Wanfang,CBM,PubMed were searched by two independent researchers to collect the randomized controlled trials(RCT)on the Shenfu,Injection by comparing integrated Western medicines(the treatment group)with the conventional Western medicine alone(the control group)in the treatment of sepsis-related myocardial injury.After the data of clinical studies that met the inclusion criteria were extracted,Jadad was used to evaluate the methodology quality,and RevMan 5.3 was used for Meta-analysis.Results:A total of 10 studies were included involving 684 participants,including 349 in the treatment group and 335 in the control group.The Jadad score of the RCTs was all 3 points.Meta-analysis results showed that,compared with conventional western medicine,Shenfu Injection helped to reduce the levels of Tnl in sepsis-related myocardial injury[SMD=-1.45,95%CI(-2.10,-0.79),P<0.0001],CK-MB[SMD=-0.72,95%CI(-1.15,-0.29),P=0.001],BNP[SMD=-2.43,95%CI(-3.60,-1.26),P<0.0001]and NT-proBNP[SMD=-2.31,95%CI(-3.72,-0.91),P=0.001],improved the levels of left ventricular ejection fraction[SMD=1.67,95%CI(0.36,2.98),P=0.01]and cardiac index[SMD=1.21,95%CI(0.42,1.99),P=0.003].Conclusions:On the basis of conventional treatment,the combination of Shenfu Injection can reduce sepsis-related myocardial injury and improve cardiac dysfunction in sepsis patients.