益气温阳活血利水方药对慢性心力衰竭疗效及客观指标影响的Meta分析  

Meta-analysis of Curative Effect and Influence of Objective Index in Chronic Heart Failure Treated by the Prescription and Medicine of Benefiting Qi and Warming Yang, Active Blood Circulation and Diuresis

作　　者：寿鑫甜 王禹萌[1] 胡志希[1] 刘建和[2] SHOU Xintian;WANG Yumeng;HU Zhixi;LIU Jianhe(Hunan University of Chinese Medicine,Changsha Hunan China 410208;The First Affiliated Hospital of Hunan University of Chinese Medicine,Changsha Hunan China 410007)

机构地区：[1]湖南中医药大学,湖南长沙410208 [2]湖南中医药大学第一附属医院,湖南长沙410007

出　　处：《中医学报》2019年第11期2479-2486,共8页Acta Chinese Medicine

基　　金：国家自然科学基金项目(81373550,81774208)

摘　　要：目的:评价益气温阳活血利水方药对慢性心力衰竭疗效及客观指标的影响,为其在临床运用提供循证依据。方法:计算机检索中国知网、万方数据库、维普期刊资源整合服务平台、PubMed等数据库中的随机对照试验。观察心功能疗效,中医证候疗效,左心室射血分数,左心室舒张末期内径,N末端脑钠肽前体(NT-proBNP)水平,6分钟步行试验,明尼苏达生存质量评分,肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、超敏C反应蛋白(high-sensitivity C-reactive protein,hs-CRP)、白细胞介素-6(interleukin,IL-6)。根据Jadad量化评分评价文献质量,采用Cochrane协作网提供的RevMan 5.3软件进行Meta分析。结果:本研究共检索论文284篇,最终纳入17篇文献,观察病例1 404例。与对照组比较,益气温阳活血利水方药明显提高心功能疗效(RR=1.25,I^2=0%,P<0.000 01)、改善心力衰竭症状(RR=1.28,I^2=0%,P<0.000 01)、提高患者左心室射血分数(SMD=0.79,I^2=88%,P<0.000 01)、减小患者左心室舒张末期内径(SMD=0.59,I^2=83%,P=0.006)、降低NT-proBNP水平(SMD=-1.32,I^2=90%,P=0.000 3)、增加6分钟步行试验距离(SMD=0.84,I^2=92%,P=0.01)、提高患者明尼苏达生存质量评分(SMD=-0.73,I^2=74%,P=0.000 4)。但其对炎性因子TNF-α、hs-CRP、IL-6(P>0.05)水平无明显影响。结论:益气温阳活血利水方药对慢性心力衰竭在心功能疗效、中医证候疗效、左心室射血分数、左心室舒张末期内径、NT-proBNP水平、6分钟步行试验、明尼苏达生存质量评分方面疗效显著,但对炎性因子TNF-α、hs-CRP、IL-6无明显影响。Objective: To evaluate curative effect and influence of objective index in chronic heart failure treated by the prescription and medicine of benefiting qi and warming yang,active blood circulation and diuresis to provide evidence-based evidence for clinical application. Methods: Randomized controlled trials were retrieved by computer in the CNKI,Wanfang Database,VIP Journal Resource Integration Service Platform,Pubmed. Heart function effects,therapeutic effect of TCM syndromes,left ventricular ejection fraction,end-diastolic diameter of left ventricle,N-terminal brain natriuretic peptide precursor( NT-proBNP) level,6-minute walking test,Minnesota quality of life score,tumor necrosis factor-alpha( TNF-alpha),high-sensitivity C-reactive protein( hsCRP) and interleukin-6( IL-6) were observed. Literature quality was evaluated based on Jadad quantitative score. Rev Man 5. 3 software provided by Cochrane Collaboration Network for Meta-analysis was adopted. Results: In this study,284 papers were retrieved,17 papers were included and 1404 cases were observed. Compared with the control group,prescription and medicine of benefiting qi and warming yang active blood circulation and diuresis can significantly improve the curative effect of cardiac function( RR = 1. 25,I^2= 0%,P < 0. 000 01),improve symptoms of heart failure( RR = 1. 28,I^2= 0%,P < 0. 000 01),increase left ventricular ejection fraction in patients( SMD = 0. 79,I^2= 88%,P < 0. 000 01),reduce the end diastolic diameter of left ventricle( SMD = 0. 59,I^2= 83%,P = 0. 006),reduce NT-proBNP level( SMD =-1. 32,I^2= 90%,P = 0. 000 3),increase 6-minute walking distance( SMD = 0. 83,P = 0. 006),and improve patients’ Minnesota quality of life score( SMD =-0. 73,I^2= 74%,P =0. 000 4). However,it had no significant effect on the levels of TNF-alpha,hs-CRP and IL-6( P > 0. 05). Conclusion: Prescription and medicine of benefiting qi and warming yang has significant curative effects on effects of chronic heart failure on cardiac function,TCM syndromes,left ventricular eject

关 键 词：益气温阳活血利水方药 慢性心力衰竭 临床疗效 META分析 

分 类 号：R2-03[医药卫生—中医学]