左西孟旦联合重组人脑利钠肽治疗脓毒症相关性心脏病的系统评价与Meta分析

Systematic evaluation and meta-analysis of levosimendan combined with recombinant human brain natriuretic peptide in the treatment of Sepsis-associated heart diseases

目的:系统性评价左西孟旦联合重组人脑利钠肽(recombinant human brain natriuretic peptide,rh-BNP)治疗脓毒症相关性心脏病的临床效果和安全性。方法:计算机检索中国知网、维普数据库、万方数据库、Pubmed数据库,汇总左西孟旦联合重组人脑利钠肽治疗脓毒症相关性心脏病的随机对照试验,检索的时间范围是建库至2024年4月。采用Cochrane推荐工具实施偏倚风险的评估,应用Review Manager 5.4软件进行Meta分析。结果:共纳入7篇文献,包括651例患者,其中对照组采用基础治疗联用左西孟旦或rh-BNP,共323例;观察组采用基础治疗联用左西孟旦及rh-BNP,共328例。经Meta分析,结果显示左西孟旦与rh-BNP两种药物联合使用,相较于单独使用二者其一,可明显减少APACHEⅡ评分(SMD=1.20,95%CI:30.92~1.47,P<0.0001),降低CK-MB水平(MD=8.81,95%CI:7.96~9.66,P<0.0001),提高LVEF水平(MD=-3.43,95%CI:-4.24~-2.62,P<0.0001),降低28d病死率(OR=2.38,95%CI:1.07~5.32,P=0.03),以上结果差异均有统计学意义,但两组在不良反应发生率方面,差异无统计学意义(P>0.05)。结论:左西孟旦联合rh-BNP在治疗脓毒症心脏疾病中疗效更明显,且临床安全性较高。基于纳入研究总数较少,仍需开展样本量更多、规模更大的高质量研究进行数据支持。

Objective:To systematically evaluate the clinical effect and safety of levosimendan combined with recombinant human brain natriuretic peptide(rh-BNP)in the treatment of sepsis-associated heart diseases.Methods:Searching the Chinese journal full-text debase(CNKI),VIP database,WanFang database and Pubmed to collect the relevant randomized controlled trials(RCTs).The search period ranges from the creation of the database to April 2024.Risk of bias was assessed using Cochrane recommended tools.Data were analysed with Reviewer Manager(RevMan)4.3 software.Results:A total of 7 RCTs with 651 patients were included.There were 323 cases in the control group which received basic treatment combined with levosimendan or rh-BNP.There were 328 cases in the observation group which received basic treatment combined with levosimendan and rh-BNP.The results of meta-analysis showed that:compared with the single use of either levosimendan or rh-BNP,combination of leveosimendan and rh-BNP could significantly reduce the APACHEⅡscore(SMD=1.20,95%CI:30.92~1.47,P<0.0001),decreased CK-MB(MD=8.81,95%CI:7.96~9.66,P<0.0001),raise the level of LVEF(MD=-3.43,95%CI:95%CI:-4.24~-2.62,P<0.0001),and reduced 28-day mortality.There was no statistically significant difference between the two groups in terms of the occurrence rate of adverse drug reaction(P>0.05).Conclusion:Levosimendan combined with rh-BNP is more effective and safer in the treatment of sepsis-associated heart diseases.Due to the small total number of included studies,high-quality studies with larger sample size and scale are still needed for data support.