人脑型利钠肽治疗慢性收缩性心力衰竭随机对照试验的Meta分析

目的了解人脑型利钠肽(BNP)治疗慢性收缩性心力衰竭患者对血流动力学方面的效应及其安全性和耐受性。方法以慢性收缩性心力衰竭为主题词,BNP和Nesiritide(重组人脑钠肽)分别为文本词,对MEDLINE数据库(1966～2007)进行检索,纳入临床随机对照试验(RCT)。结果对13个RCT的纳入对象、方法学和结果等方面进行评价。Nesifitide可平均降低肺毛细血管楔压(PCWP)4.06 mm Hg,95%可信区间(95%CI)[-4.79,-3.33,(P<0.01)];增加心脏指数(CI)0.08 L·min~(-1)·m~(-2),95%CI[0.02,0.15,(P=0.01)],不同程度地降低心率(HR),改善血流动力学指标以及心电图指标。对高危患者使用Nesiritide可降低各种原因的病死率。结论BNP有效改善心力衰竭患者的血流动力学,减少严重心力衰竭患者远期病死率,治疗量安全能耐受,推荐小剂量使用。

Meta analysis for a randomized and controlled trial of the therap euticeffect of human b type natriuretic peptide on chronic congestive heart failure

Objective To investigate the effect of human b-type natriuretic peptide （BNP） on hemodynamics in treating patients with chronic congestive heart failure （CHF） and its safety and tolerance. Methods Using CHF as subjective words and BNP and Nesifitide as test words respectively, to search and select the data in MEDLINE Database and to conduct randomized contmlledtrials （RCT） .Results A total of 13 clinical RCT were included. Their inclusions, methodology and results were evaluated. Nesiritide could decrease pulmonarycapillary wedge pressure （PCWP） by average 4.06 mmHg, 95% CI[ - 4.79, - 3.33, （ P 〈 0.01 ） ], and which could increase cardiac index （CI） by 0.08 L·min^-1·m^2,95% CI[0.02,0.15,（ P =0.01）] ,and could decrease heart rate and improve the parameters of hemorrheology and ECG. For the patients with high risk, Nesiritide could decrease mortality causedby different reasons. Conclusion BNP can effectively improve hemodynamicsin patients with CHF, and can reduce longterm mortality in patients with severe CHF. The treatment doses are safe and tolerant, so a low-dose BNP is recommended to be used in clinic.