肌少症对心力衰竭患者预后影响的系统评价

The effects of sarcopenia on the prognosis of patients with heart failure:a systematic review

目的系统评价肌少症对心力衰竭患者预后的影响。方法计算机检索PubMed、Web of Science、Embase、The Cochrane Library、CBM、CINAHL、CNKI、万方和维普数据库,并使用“滚雪球”法检索肌少症对心力衰竭患者预后相关的队列研究,检索时限从建库至2022年6月。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.4软件进行Meta分析。结果本研究最终纳入8篇队列研究,包括2261例患者。Meta分析结果显示,与非肌少症相比,有肌少症的心力衰竭患者全因死亡风险更高[HR=1.32,95%CI(1.18,1.47),P<0.001],且肌少症也会增加心力衰竭患者心源性不良事件发生的风险[HR=1.01,95%CI(1.01,1.02),P<0.001]。亚组分析结果显示,肌少症对急性失代偿性心力衰竭患者的全因死亡没有影响[HR=1.26,95%CI(1.00,1.59),P=0.05],但会增加慢性心力衰竭患者全因死亡的风险[HR=1.61,95%CI(1.09,2.36),P=0.02]。结论本研究结果显示肌少症对心力衰竭患者的预后具有预测价值,但受纳入研究数量的限制,结论尚待更多高质量研究验证。

Objective To assess the effects of sarcopenia on the prognosis of patients with heart failure(HF).Methods A comprehensive search was conducted in PubMed,Web of Science,Embase,The Cochrane Library,CBM,CINAHL,CNKI,Wanfang and VIP databases from their inception to June 2022.Cohort studies related to sarcopenia and HF prognosis were collected by“snowball”method.Two reviewers independently screened articles,extracted data,and evaluated risk of bias of the included studies.Meta-analysis was then performed using RevMan 5.4 software.Results Finally 8 cohort studies involving 2261 patients were included.The meta-analysis showed that HF patients with sarcopenia had a higher risk of all-cause death than those without sarcopenia[HR=1.32,95%CI(1.18,1.47),P<0.001],and sarcopenia also increases the risk of cardiogenic adverse events in HF patients[HR=1.01,95%CI(1.01,1.02),P<0.001].Subgroup analysis showed that sarcopenia had no effect on all-cause death in patients with ADHF[HR=1.26,95%CI(1.00,1.59),P=0.05],but increased the risk of all-cause death in patients with CHF[HR=1.61,95%CI(1.09,2.36),P=0.02].Conclusion The results of this study indicate that sarcopenia has predictive value for the prognosis of HF patients.Due to limited quantity and quality of included studies,more high quality studies are needed to verify above conclusions.