真武汤合血府逐瘀汤联合西医治疗慢性心力衰竭疗效的Meta分析

Meta-analysis on Zhenwu Decoction and Xuefu Zhuyu Decoction combined with Western medicine in the treatment of chronic heart failure

目的 观察真武汤合血府逐瘀汤联合西医治疗慢性心力衰竭(CHF)的临床疗效。方法 将中国知网、万方数据知识服务平台、维普中文科技期刊全文数据库、Web of Knowledge数据库中收录的有关真武汤合血府逐瘀汤联合西医治疗CHF临床疗效的临床随机对照试验(RCT),按照纳入和排除标准选取文献,并提取文中的数据,用Revman5.3软件进行Meta分析。结果 共纳入了12篇文献,包括1006例患者,其中试验组和对照组各503例。对照组采用常规西医治疗,试验组采用真武汤合血府逐瘀汤联合西医治疗。根据Cochrane手册的评价标准,所纳入的文献均为中低质量文献。(1)临床疗效的Meta分析:采用固定效应(FE)模型进行分析,结果显示加权均数差(WMD)=1.24, 95%置信区间(CI)=(1.17, 1.31), P<0.01,说明采用真武汤合血府逐瘀汤联合西医治疗较常规西医治疗可以提高CHF患者的临床有效率。(2) N末端B型利钠肽前体(NT-proBNP)的Meta分析:采用FE模型进行分析,结果显示WMD=-144.35, 95%CI=(-164.97,-123.74), P<0.01,说明西医加用真武汤合血府逐瘀汤相对于常规西医治疗,可以更好地降低CHF患者的NT-proBNP水平。(3)左心室射血分数的Meta分析:采用随机效应(RE)模型进行分析,结果显示WMD=9.37, 95%CI=(6.47, 12.26), P<0.01,说明西医加用真武汤合血府逐瘀汤治疗较常规西医治疗可以提高CHF患者的左心室射血分数。(4)左心室舒张末期内径的Meta分析:采用FE模型进行分析,结果显示WMD=-3.85, 95%CI=(-4.91,-2.79), P<0.01,说明西医加用真武汤合血府逐瘀汤较常规西医治疗可以降低CHF患者的左心室舒张末期内径。(5)不良反应分析:西医联合真武汤合血府逐瘀汤治疗CHF能够减少不良反应的发生。以临床有效率的Meta分析结果进行发表偏倚的分析,漏斗图结果显示各项研究平均地分布在中线两侧,但是图形缺乏对称性,考虑可能存在发表偏倚。结论 真武汤合血府逐瘀汤联合西医治疗可显著提高CHF患者的临床疗效。

Objective To observe the clinical efficacy of Zhenwu Decoction and Xuefu Zhuyu Decoction combined with Western medicine in the treatment of chronic heart failure(CHF).Methods The random control trial(CRT)of Zhenwu Decoction and Xuefu Zhuyu Decoction combined with Western medicine for the treatment of chronic heart failure included in the databases of CNKI,WANFANG database,VIP and Web of Knowledge were selected according to the inclusion and exclusion criteria,and the data in the text were extracted and analyzed in Meta-analysis using the software of Revman 5.3.Results A total of 12 papers were finally enrolled which included 1006 patients,with 503 patients in the experimental group and 503 patients in the control group.The control group was treated with conventional Western medicine,and the experimental group was treated with Zhenwu Decoction and Xuefu Zhuyu Decoction combined with Western medicine.Compared with the control group,the experimental group had higher clinical efficiency,decreased pro-bnp level,increased LVEF,decreased LVEDD,and lower incidence of adverse reactions.According to the evaluation criteria of the Cochrane Handbook,the included papers were of low to medium quality.(i)Meta-analysis of clinical efficacy:The fixed effect(FE)model was used for the analysis,and the results showed that the weighted mean difference(WMD)=1.24,95%confidence interval(CI)=(1.17,1.31),P<0.01,which indicated that Zhenwu Decoction and Xuefu Zhuyu Decoction combined with Western medicine could increase the clinical efficacy rate of patients with CHF compared with the conventional Western medical treatment.(ii)Meta-analysis of N-terminal pro-B-type natriuretic peptide(NT-proBNP):The FE model was used for the analysis,and the results showed that WMD=-144.35,95%CI=(-164.97,-123.74),P<0.01,which indicated that Zhenwu Decoction and Xuefu Zhuyu Decoction could better reduce the level of NT-proBNP in patients with CHF relative to the conventional Western medical treatment.(iii)Meta-analysis of left ventricular ejection fraction:the random effect(RE)model was used for the analysis,and the results showed that WMD=9.37,95%CI=(6.47,12.26),P<0.01,which indicated that Zhenwu Decoction and Xuefu Zhuyu Decoction could improve the left ventricular ejection fraction of patients with CHF compared with the conventional Western medical treatment.(iv)Meta-analysis of left ventricular end-diastolic diameter:the FE model was used for the analysis,and the results showed that WMD=-3.85,95%CI=(-4.91,-2.79),P<0.01,which indicated that Zhenwu Decoction and Xuefu Zhuyu Decoction could reduce the left ventricular end-diastolic internal diameter of patients with CHF compared with the conventional western medical treatment.(v)Analysis of adverse reactions:Western medicine combined with Zhenwu Decoction and Xuefu Zhuyu Decoction could reduce the occurrence of adverse reactions in the treatment of CHF.The results of Meta-analysis of clinical effectiveness were used for the analysis of publication bias,and the results of the funnel plot showed that the studies were evenly distributed on both sides of the midline,but the graphs lacked symmetry,and possible publication bias was considered.Conclusion Zhenwu Decoction and Xuefu Zhuyu Decoction combined with Western medicine can significantly improve the clinical efficacy of CHF patients.