β受体阻滞剂对蒽环类药物所致亚临床心脏毒性疗效的meta分析  

Efficacy ofβreceptor blockers on subclinical cardiotoxicity induced by anthracyclines:a meta-analysis

作　　者：王媚 张楠[2] 徐柳月 姜甜甜 翁悦 唐晓琼[1] WANG Mei;ZHANG Nan;XU Liuyue;JIANG Tiantian;WENG Yue;TANG Xiaoqiong(Department of Hematology,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China;Department of Cardiology,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China)

机构地区：[1]重庆医科大学附属第一医院血液内科,重庆400016 [2]重庆医科大学附属第一医院心血管内科,重庆400016

出　　处：《现代医药卫生》2021年第17期2937-2942,共6页Journal of Modern Medicine & Health

摘　　要：目的探讨β受体阻滞剂对亚临床蒽环类药物(ANT)所致心脏毒性(AIC)的有效性及二维斑点追踪技术(2D-STI)测量的整体纵向应变(GLS)监测亚临床AIC的临床价值。方法通过计算机检索PubMed、Web of science、Embase、Cochrane library、万方、知网、维普等数据库,检索期限为建库至2020年9月。检索β受体阻滞剂预防性治疗AIC的临床对照试验。由两名研究者按既定纳入和排除标准独立筛选文献、提取资料和评估纳入研究的方法学质量,采用RevMan5.3统计软件进行meta分析。结果全面检索得到179篇相关文献。最终纳入4篇,共290例患者,使用β受体阻滞剂的干预组样本量为140例,空白及安慰剂对照组样本量为150例。Meta分析结果显示,对照组与干预组的终值GLS、化疗前后的GLS变化值比较,差异均有统计学意义(SMD=-0.42,95%CI-0.66~-0.19,P<0.001,I 2=34%;SMD=0.36,95%CI 0.12~0.59,P=0.003,I 2=55%),而化疗前后的左室射血分数(LVEF)变化值比较,差异无统计学意义(SMD=0.05,95%CI-0.22~0.33,P=0.70,I 2=0)。结论β受体阻滞剂对亚临床AIC具有保护作用,相较于LVEF,GLS更能准确反映亚临床AIC。Objective To explore the effectiveness ofβreceptor blockers on subclinical cardiotoxicity(AIC)induced by anthracyclines(ANT)and the clinical value of global longitudinal strain(GLS)on monitoring subclinical AIC measured by two-dimensional speckle tracking technology(2D-STI).Methods The electronic databases such as PubMed,Web of science,Embase,Cochrane library,Wanfang,CNKI and VIP from the database establishment to September 2020 were retrieved.All the clinical controlled trials ofβreceptor blockers for preventive treatment of AIC were selected.Two investigators independently screened the literature according to the established inclusion and exclusion criteria,extracted data and evaluated the methodological quality of the included studies.The RevMan5.3 statistical software was used for meta-analysis.Results A comprehensive search yielded 179 relevant articles.Finally,4 articles with a total of 290 patients were included.The sample size of the intervention group usingβreceptor blocker was 140 cases,and of the blank or placebo control group was 150 cases.Meta-analysis results indicated those the final value of GLS,ΔGLS had a statistically significant differences(SMD=-0.42,95%CI-0.66--0.19,P<0.001,I 2=34%;SMD=0.36,95%CI 0.12-0.59,P=0.003,I 2=55%).While there was no significant difference inΔLVEF(SMD=0.05,95%CI-0.22-0.33,P=0.70,I 2=0).Conclusionsβreceptor blockers may have a protective effect on subclinical AIC.Compared with LVEF,GLS can more accurately reflect subclinical AIC.

关 键 词：蒽环类药物 整体纵向应变 Β-受体阻滞剂 心脏毒性 META分析 

分 类 号：R541.9[医药卫生—心血管疾病] R730.6[医药卫生—内科学]