中药汤剂联合沙库巴曲缬沙坦治疗慢性心力衰竭疗效及安全性的Meta分析

Efficacy and Safety of Traditional Chinese Herbal Decoction Combined with Sacubitril/Valsartan in the Treatment of Chronic Heart Failure:a Meta-analysis

目的:系统评价中药汤剂联合沙库巴曲缬沙坦(LCZ696)治疗慢性心力衰竭(CHF)的有效性和安全性。方法:检索PubMed、the Cochrane Library、EMbase、中国学术期刊全文数据库、万方数据库、维普数据库和中国生物医学文献数据库中关于中药汤剂联合LCZ696治疗CHF的随机对照试验,检索时限为建库至2022年9月1日。采用Cochrane偏倚风险评估工具对纳入文献进行质量评价,应用Rev Man 5.3软件进行Meta分析。结果:共纳入14项研究,涉及1 121例病人。Meta分析显示:与常规治疗基础上加用LCZ696比较,中药汤剂联合LCZ696治疗CHF的有效率更高[RR=1.23,95%CI(1.15,1.31),P<0.000 01],治疗后6 min步行距离[MD=46.41,95%CI(29.57,63.25),P<0.000 01]及左室射血分数[MD=5.07,95%CI(3.14,7.01),P<0.000 01]明显增加,治疗后左心室舒张末期内径[MD=-2.76,95%CI(-3.96,-1.55),P<0.000 01]及血清N末端脑利钠肽前体[SMD=-2.11,95%CI(-3.13,-1.10),P<0.000 1]水平明显降低,两组不良反应发生率比较差异无统计学意义[RR=0.68,95%CI(0.33,1.38),P=0.28]。结论:现有证据表明,中药汤剂联合LCZ696治疗CHF可显著提高临床疗效且安全性较好。

Objective:To evaluate the efficacy and safety of traditional Chinese herbal decoction combined with sacubitril/valsartan(LCZ696)for the treatment of chronic heart failure(CHF).Methods:Randomized controlled trials of traditional Chinese herbal decoction combined with LCZ696 in the treatment of CHF were searched from PubMed,the Cochrane Library,EMbase,Wanfang Data,Chinese Science and Technology Journal Database(VIP),and Chinese Biomedical Literature Database.The search period was from the establishment of data to September 1,2022.Cochrane bias risk assessment tool was used to evaluate the quality of the included literature.Meta-analysis was performed by RevMan 5.3 software.Results:A total of 14 studies were included,involving 1121 patients.Meta-analysis showed that compared with LCZ696 alone,traditional Chinese herbal decoction combined with LCZ696 showed higher clinical effective rate for the treatment of CHF(RR=1.23,95%CI 1.15-1.31,P<0.00001),and 6 min walking distance(MD=46.41,95%CI 29.57-63.25,P<0.00001)and left ventricular ejection fraction(MD=5.07,95%CI 3.14-7.01,P<0.00001)significantly increased,and left ventricular end-diastolic diameter(MD=-2.76,95%CI-3.96--1.55,P<0.00001)and serum N-terminal brain natriuretic peptide precursors(SMD=-2.11,95%CI-3.13--1.10),P<0.0001)significantly decreased.There was no significant difference in the incidence of adverse reactions between two groups(RR=0.68,95%CI 0.33-1.38,P=0.28).Conclusion:Available evidence shows that traditional Chinese herbal decoction co mbined with LCZ696 can significantly improve clinical efficacy with safety for the treatment of CHF.