重组人脑利钠肽对急性心肌梗死患者血管内皮功能影响的Meta分析

Meta-analysis of the effects of recombinant human brain natriuretic peptide on endothelial function in patients with acute myocardial infarction

目的探讨重组人脑利钠肽对急性心肌梗死患者血管内皮功能的影响。方法检索PubMed、Cochrane图书馆、Web of Science、Embase、中国知网(CNKI)、万方、维普中文科技期刊数据库(VIP)、中国生物医学文献数据库(CBM),获取从建库至2023年3月8日的关于重组人脑利钠肽对急性心肌梗死患者内皮功能影响的随机对照试验。依据纳入与排除标准,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RevMan5.3、Stata14软件分析比较联用重组人脑利钠肽与常规治疗后急性心肌梗死患者血流介导的血管舒张功能(FMD)、一氧化氮(NO)水平及内皮素-1水平。结果纳入10篇文献共956例患者。Meta分析结果显示:干预组在常规治疗基础上联用重组人脑利钠肽,治疗后的FMD(MD=5.14,95%CI:4.55~5.73,Z=16.96,P<0.01)、NO水平(MD=6.93,95%CI:5.92~7.95,Z=13.41,P<0.01)均高于对照组。亚组分析显示,急性心肌梗死的诊断标准不同可能是异质性来源之一,世界卫生组织(WHO)急性心肌梗死诊断标准组纳入的研究之间异质性较小(I2<50%,Q检验P>0.1),干预组FMD(MD=5.76,95%CI:5.31~6.20,Z=25.17,P<0.01)、NO水平(MD=7.55,95%CI:6.64~8.46,Z=16.30,P<0.01)均高于对照组。非WHO急性心肌梗死诊断标准组各研究之间异质性较大(I2>50%,Q检验P<0.1),干预组FMD(MD=4.56,95%CI:3.55~5.58,Z=8.82,P<0.01)、NO水平(MD=6.25,95%CI:4.48~8.03,Z=6.91,P<0.01)均高于对照组。干预组内皮素-1水平(MD=-10.68,95%CI:-12.41~-8.96,Z=12.16,P<0.01)低于对照组。结论重组人脑利钠肽可以提高急性心肌梗死患者的FMD及NO水平,降低内皮素-1的水平,从而起到改善血管内皮功能的作用。

Objective To analyze the effects of recombinant human brain natriuretic peptide on endothelial function in patients with acute myocardial infarction.Methods Randomized controlled trials(RCT)about the effects of recombi⁃nant human brain natriuretic peptide on endothelial function in patients with acute myocardial infarction published from the establishment of the database to March 8th 2023 were searched in PubMed,Cochrane Library,Web of Science,Embase,CNKI,Wanfang,Wipro Chinese Technology Publications(VIP),Chinese biomedical literature database(CBM).Ac⁃cording to the inclusion and exclusion criteria,two reviewers screened the included studies,extracted data and assessed the risk of bias of included studies respectively.RevMan 5.3 software and Stata14 software were used to compare the levels of flow-mediated dilatation(FMD),nitric oxide(NO),and endothelin-1 in patients with acute myocardial infarction after combined use of recombinant human brain natriuretic peptide and conventional treatment.Results A total of 10 RCTs in⁃volving 956 patients were analysed.The results of the meta-analysis showed that:The levels of FMD(MD=5.14,95%CI:4.55-5.73,Z=16.96,P<0.01),NO(MD=6.93,95%CI:5.92-7.95,Z=13.41,P<0.01)in patients in the intervention group after treatment of recombinant human brain natriuretic peptide combined with the conventional treatment were higher compared with those in patients in the control group,and subgroup analysis showed that the difference of diagnostic criteria of acute myocardial infarction might be one source of heterogeneity.In the group of World Health Organization(WHO)di⁃agnostic criteria of acute myocardial infarction,the included trials displayed small heterogeneity(I2<50%,P>0.1),the lev⁃els of FMD(MD=5.76,95%CI:5.31-6.20,Z=25.17,P<0.01),NO(MD=7.55,95%CI:6.64-8.46,Z=16.30,P<0.01)were higher in the intervention group than those in the control group.In the group of non-WHO diagnostic criteria of acute myocardial infarction,the included trials displayed great heterogeneity(I2>50%,P<0.1),the levels of FMD(MD=4.56,95%CI:3.55-5.58,Z=8.82,P<0.01),NO(MD=6.25,95%CI:4.48-8.03,Z=6.91,P<0.01)were higher in the intervention group than those in the control group.The level of endothelin-1(MD=-10.68,95%CI:-12.41--8.96,Z=12.16,P<0.01)in patients in the intervention group was lower compared with that in patients in the control group.Con⁃clusion Recombinant human brain natriuretic peptide may play a role in the improvement of endothelial function in pa⁃tients with acute myocardial infarction by increasing the level of FMD and NO,while decreasing the level of endothelin-1.