中药干预慢性心力衰竭伴利尿剂抵抗的Meta分析  

Meta Analysis of Traditional Chinese Medicine in the Treatment of Chronic Heart Failure with Diuretic Resistance

作　　者：王安铸 马晓昌[1] WANG Anzhu;MA Xiaochang(Xiyuan Hospital,China Academy of Chinese Medical Sciences,Beijing100091,China)

机构地区：[1]中国中医科学院西苑医院,北京100091

出　　处：《中西医结合心脑血管病杂志》2020年第15期2374-2381,共8页Chinese Journal of Integrative Medicine on Cardio-Cerebrovascular Disease

基　　金：国家自然科学基金项目(No.81273932)。

摘　　要：目的系统评价中药干预慢性心力衰竭伴利尿剂抵抗的疗效及安全性。方法检索PubMed、Cochrane Library、Web of Science、EMbase、中国知网数据库、万方数据库、维普全文数据库、中国生物医学文献数据库。检索年限从建库至2019年1月1日。对纳入的临床随机对照试验(RCT)用Cochrane手册进行偏倚风险评估,用RevMan 5.3软件进行Meta分析。结果纳入10项RCT研究,共计622例慢性心力衰竭伴利尿剂抵抗病人。与对照组相比,试验组24 h尿量增加[MD=0.58,95%CI(0.31,0.85),P<0.0001],N末端B型利钠肽原(NT-proBNP)降低[MD=-1.28,95%CI(-2.15,-0.40),P=0.004],左室射血分数(LVEF)增加[MD=3.37,95%CI(1.68,5.06),P<0.0001],6 min步行距离(6MWD)增加[MD=0.46,95%CI(0.15,0.76),P=0.004],美国纽约心脏病协会(NYHA)心功能分级改善[OR=2.33,95%CI(1.50,3.62),P=0.0002],中医证候改善[OR=4.09,95%CI(2.26,7.40),P<0.00001],心力衰竭症状疗效(Lee评分)改善[OR=3.11,95%CI(1.17,8.24),P=0.02],体重减轻[MD=-2.37,95%CI(-3.50,-1.25),P<0.0001],不良反应少。结论当前证据表明,在常规治疗基础上加用中药对慢性心力衰竭伴利尿剂抵抗病人的治疗是有利的。Objective To evaluate the efficacy and safety of traditional Chinese medicine(TCM)in the treatment of chronic heart failure with diuretic resistance.Methods We searched the databases of PubMed,Cochrane Library,Web of Science,EMBASE,China National Knowledge Infrastructure(CNKI),Wanfang database,VIP full text database,and Chinese Biomedical Literature database(CBM).The retrieval period was from the database construction to January 1,2019.Risk of bias was assessed using the Cochrane manual for included randomized controlled trials(RCTs).Meta analysis was performed using Rev Man 5.3 software.Results A total of 10 RCTs were enrolled,involving 622 patients with chronic heart failure and diuretic resistance.Compared with the control group,the 24 h urine volume increased[MD=0.58,95%CI(0.31,0.85),P<0.0001],N terminal pro B type natriuretic peptide(NT-proBNP)decreased[MD=-1.28,95%CI(-2.15,-0.40),P=0.004],left ventricular ejection fraction(LVEF)increased[MD=3.37,95%CI(1.68,5.06),P<0.0001],six-minute walk distance(6MWD)increased[MD=0.46,95%CI(0.15,0.76),P=0.004],New York Heart Association(NYHA)classification improved[OR=2.33,95%CI(1.50,3.62),P=0.0002],TCM syndromes improved[OR=4.09,95%CI(2.26,7.40),P<0.00001],Lee sove improved[OR=3.11,95%CI(1.17,8.24),P=0.02],blody weight decreased[MD=-2.37,95%CI(-3.50,-1.25),P<0.0001],and adverse reactions were lower in the TCM interv ention group.Conclusion Current evidences show that TCM onthe basis of conventional treatment is beneficial to the treatment of patients with chronic heart failure and diuretic resistance.

关 键 词：心力衰竭 利尿剂抵抗 中药 META分析 

分 类 号：R541.6[医药卫生—心血管疾病] R256.2[医药卫生—内科学]