静脉与口服补铁治疗CHF伴ID病人有效性及安全性的Meta分析

Efficacy and safety of intravenous and oral iron supplementation in the treatment of CHF patients with ID:a meta-analysis

目的:系统评价静脉与口服补铁治疗慢性心力衰竭(chronic heart failure,CHF)伴铁缺乏(iron deficiency,ID)病人的有效性和安全性,为临床用药提供循证依据。方法:计算机检索PubMed、Web of Science、Embase、the Cochrane Library、Clinical Trials、中国知网、万方数据、维普数据、中国生物医学文献数据库中关于静脉与口服补铁治疗CHF伴ID病人的随机对照试验,检索时限为建库至2022年11月8日。由2名研究者按纳入排除标准独立筛选文献、提取资料、评估文献质量,并采用RevMan 5.3软件进行Meta分析。结果:最终纳入5篇文献,共905例病人。Meta分析结果显示有效性:与口服补铁相比,静脉补铁可提高CHF伴ID病人的Hb[SMD=0.67,95%CI(0.52,0.82),Z=8.55,P<0.00001]和TSAT[WMD=1.45,95%CI(0.03,2.87),Z=2.00,P=0.05]、延长6MWT[WMD=19.13,95%CI(4.97,33.30),Z=2.65,P=0.008];两者改善铁蛋白效果差异无统计学意义[SMD=0.07,95%CI(-0.17,0.30),Z=0.54,P=0.59]。安全性:静脉与口服补铁在药物不良反应[OR=0.59,95%CI(0.33,1.05),Z=1.79,P=0.07]和全因死亡或心血管事件发生上差异无统计学意义[OR=1.11,95%CI(0.61,2.01),Z=0.33,P=0.74]。描述性分析显示,静脉补铁降低NT-ProBNP效果优于口服补铁。结论:静脉补铁对提高CHF伴CD病人的Hb和TSAT、延长6MWT和降低NT-proBNP的效果优于口服补铁,两种补铁治疗安全性及其他方面差异无统计学意义,仍需更多高质量的研究进一步论证。

Objective:To systematically evaluate the effectiveness and safety of intravenous and oral iron supplementation in treating chronic heart failure(CHF)patients with iron deficiency(ID)and provide an evidence-based basis for clinical medication.Methods:Randomized controlled trials(RCTs)on intravenous and oral iron supplementation in CHF patients with ID were retrieved from PubMed,Web of Science,Embase,the Cochrane Library,Clinical Trials,China National Knowledge Infrastructure(CNKI),WanFang Database,VIP Database,and China Biomedical Literature Database,from the establishment of the database to November 8,2022.According to the inclusion and exclusion criteria,2 researchers independently screened the literature,extracted data,evaluated the quality of the literature,and performed meta-analysis using RevMan 5.3 software.Results:Finally,a total of 5 papers were included,involving 905 patients.The meta-analysis results showed that in effectiveness:compared with oral iron supplementation,intravenous iron supplementation was better in increasing Hb[SMD=0.67,95%CI(0.52,0.82),Z=8.55,P<0.001]and TSAT[WMD=1.45,95%CI(0.03,2.87),Z=2.00,P=0.05],and extending 6MWT[WMD=19.13,95%CI(4.97,33.30),Z=2.65,P=0.008];there was no statistically significant difference in improving ferritin among patients[SMD=0.07,95%CI(-0.17,0.30),Z=0.54,P=0.59].In safety:there was no significant difference between intravenous and oral iron supplementation in adverse drug reactions[OR=0.59,95%CI(0.33,1.05),Z=1.79,P=0.07]and all-cause death or cardiovascular events[OR=1.11,95%CI(0.61,2.01),Z=0.33,P=0.74].Descriptive analysis showed that intravenous iron supplementation was more effective than oral iron supplementation in reducing NT-ProBNP.Conclusions:Intravenous iron supplementation was more effective than that of oral iron supplementation in improving Hb and TSAT,prolonging 6MWT,and reducing NT-proBNP in CHF patients with CD.More high-quality research with further evidenceis still needed in the future.