中药治疗射血分数降低型心力衰竭的Meta分析

Meta-analysis of Traditional Chinese Medicine in the Treatment of Heart Failure with Reduced Ejection Fraction

目的:系统评价中药治疗射血分数降低型心力衰竭(HFrEF)的有效性及安全性。方法:计算机检索中国知网(CNKI)、万方(WanFang)、维普(VIP)、中国生物医学文献数据库(CBM)、PubMed、the Cochrane Library和EMbase,检索时限为2011年1月1日—2020年10月1日,纳入中药治疗HFrEF的随机对照试验,利用Cochrane协作网偏倚风险评价标准对纳入的文献进行质量评价,采用RevMan 5.4.1软件对主要结局指标左室射血分数(LVEF)、临床总有效率及次要结局指标Lee氏心力衰竭计分有效率、脑钠肽(BNP)/N末端脑钠肽前体(NT-proBNP)、6 min步行试验(6MWT)、明尼苏达心力衰竭生活质量评分(MLHFQ)进行Meta分析。结果:共纳入30项研究,涉及3 291例病人。Meta分析结果显示,与对照组比较,试验组可提高临床总有效率[OR=2.85,95%CI(2.29,3.56),P<0.000 1],改善LVEF[MD=6.75,95%CI(5.65,7.84),P<0.000 01],降低BNP[MD=-137.94,95%CI(-203.26,-72.63),P<0.000 01]、NT-proBNP水平[MD=-302.25,95%CI(-412.26,-192.24),P<0.000 01],提高6MWT[MD=64.93,95%CI(51.88,77.97),P<0.000 01]、MLHFQ[MD=-6.78,95%CI(-8.56,-5.01),P<0.000 01]、Lee氏心力衰竭计分有效率[OR=3.08,95%CI(1.78,5.35),P<0.000 1]。结论:现有证据表明,中西医结合治疗可提高HFrEF病人临床疗效、LVEF,降低BNP、NT-proBNP水平,提高生活质量及运动耐力,且安全性较高。

Objective:To evaluate the efficacy and safety of traditional Chinese medicine in the treatment of heart failure with reduced ejection fraction(HFrEF).Methods:CNKI,WanFang,VIP,CBM,PubMed,the Cochrane Library,and EMbase were searched by computer from January 1,2011 to October 1,2020.Randomized controlled trials of traditional Chinese medicine in the treatment of HFrEF were included.The quality of the included literature was evaluated using the Cochrane Collaborative network bias risk assessment criteria.RevMan 5.4.1 software was used for Meta-analysis including the efficacy rate of clinical cardiac function,left ventricular ejection fraction(LVEF)and Lee's heart failure score,brain natriuretic peptide(BNP),N-terminal brain natriuretic peptide precursor(NT-proBNP),6 min walking distance(6MWT),and Minnesota Living with Heart Failure Questionnaire(MLHFQ).Results:A total of 30 literatures were included,including 3291 patients.The results of Meta-analysis showed that compared with the control group,clinical efficacy of cardiac function in the experimental group(OR=2.85,95%CI 2.29-3.56,P<0.00001),LVEF(MD=6.75,95%CI 5.65-7.84,P<0.00001)was better,BNP(MD=-137.94,95%CI-203.26--72.63,P<0.0001)and NT-proBNP(MD=-302.25,95%CI-412.26--192.24,P<0.00001)were decreased,6MWT(MD=64.93,95%CI 51.88-77.97,P<0.00001)was prolonged,MLHFQ(MD=-6.78,95%CI-8.56--5.01,P<0.00001)and effective rate of Lee's heart failure score(OR=3.08,95%CI 1.78-5.35,P<0.0001)were increased.Conclusion:The current evidence showed that the combination of Chinese and Western medicine could improve the clinical efficacy and LVEF of HFrEF patients,reduce the level of BNP and NT-proBNP,improve the quality of life and exercise endurance,with better safety.