国内磷酸肌酸钠治疗冠心病心力衰竭的Meta分析

目的 采用Meta分析评价国内磷酸肌酸钠对冠心病心力衰竭的临床疗效。方法 计算机检索中国期刊全文数据库、中国生物医学文献数据库、维普中文期刊及万方数据库中关于磷酸肌酸钠治疗冠心病心力衰竭的研究报道。文献检索时限为建库至2018年12月。采用RevMan5.3软件对纳入的文献数据进行Meta分析。结果 共纳入文献16篇，累计1448例患者。Meta分析结果显示:①总体疗效评价:磷酸肌酸钠组治疗冠心病心力衰竭的临床疗效高于常规治疗组（OR=4.93，95%CI 3.47~7.01，P＜0.001）；②不同疗程疗效评价:疗程14 d时，磷酸肌酸钠组比常规治疗组能更有效的改善冠心病心力衰竭患者的心脏功能（OR=6.34，95%CI 3.90~10.29，P＜0.001）；疗程＜14 d时，磷酸肌酸钠组改善冠心病心力衰竭患者的心功能与常规治疗组比较，差异不显著（OR=2.57，95%CI 1.29~5.09，P＞0.001）；疗程＞14 d时，磷酸肌酸钠组比常规治疗组能更有效的改善冠心病心力衰竭患者的心脏功能（OR=5.44，95%CI 2.42~12.23，P＜0.001）。③剂量疗效评价:对疗程14 d的9项研究根据不同剂量进行亚组分析，剂量为1 g ivgtt qd时，磷酸肌酸钠组改善冠心病心力衰竭患者的心功能与常规治疗组比较，差异不显著（OR=4.87，95%CI 1.7~13.98，P＞0.001）；剂量为1 g ivgtt bid时，磷酸肌酸钠组比常规治疗组能更有效的改善冠心病心力衰竭患者的心脏功能（OR=9.73，95%CI 4.05~23.40，P＜0.001）；剂量为2 g ivgtt qd时，磷酸肌酸钠组比常规治疗组能更有效的改善冠心病心力衰竭患者的心脏功能（OR=6.11，95%CI 2.93~12.72，P＜0.001）；同时1 g bid剂量的改善效果优于2 g bid和1 g qd。结论 磷酸肌酸钠能够缓解冠心病心力衰竭患者临床症状，改善心功能，具有一定的临床疗效，同时磷酸肌酸钠改善冠心病心力衰竭患者心功能的效果与给药剂量和次数有一定的相关性。

Meta-analysis of Sodium Creatine Phosphate in the Treatment of Coronary Heart Disease with Heart Failure in China

Objective Meta-analysis was used to evaluate the clinical efficacy of sodium creatine phosphate in patients with coronary heart disease and heart failure. Methods Computer-researched Chinese Journal Full-text Database, China Biomedical Literature Database, Weipu Chinese Journal and Wanfang Database reported on the treatment of coronary heart disease with heart failure by sodium creatine phosphate. The time limit for document retrieval is to build the library until December 2018. Meta-analysis of the included literature data was performed using RevMan 5.3 software. Results A total of 16 articles were included in the literature, with a total of 1448 patients. Meta-analysis results showed:①Overall efficacy evaluation: The clinical efficacy of sodium creatine phosphate group in the treatment of coronary heart disease with heart failure was significantly higher than that of the conventional treatment group (OR=4.93, 95%CI3.47~7.01, P<0.001); ②Efficacy evaluation of different courses of treatment: At 14 d of treatment, the sodium creatine phosphate group was more effective than the conventional treatment group in improving cardiac function in patients with coronary heart disease (OR=6.34, 95%CI3.90~10.29,P<0.001); When the course of treatment was <14 d, the cardiac function of patients with heart failure in patients with coronary heart disease was significantly different from that of the conventional treatment group (OR=2.57, 95%CI1.29~5.09, P>0.001). When the course of treatment was >14 d, The sodium creatine phosphate group was more effective than the conventional treatment group in improving cardiac function in patients with coronary heart disease (OR=5.44, 95%CI2.42~12.23, P<0.001). ③Evaluation of different doses of efficacy: 9 cases of 14 d of treatment were subgroup analysis according to different doses. When the dose was 1 g ivgtt qd, the difference of cardiac function between patients with heart disease and coronary heart disease was significantly different from that of conventional treatment group. (OR=4.87, 95%CI1.7~13.98, P>0.001); at the dose of 1 g ivgtt bid, the sodium creatine phosphate group was more effective than the conventional treatment group in improving cardiac function in patients with coronary heart disease (OR= 9.73, 95%CI4.05~23.40,P<0.001); when the dose was 2 g ivgtt qd, the sodium creatine phosphate group was more effective than the conventional treatment group in improving cardiac function in patients with coronary heart disease (OR=6.11, 95%CI2.93~12.72, P<0.001); the improvement of 1 g bid dose was better than 2 g qd and 1 g qd. Conclusion Sodium creatine phosphate can alleviate the clinical symptoms of patients with coronary heart disease and improve cardiac function, and has certain clinical efficacy. At the same time, the effect of sodium creatine phosphate on improving cardiac function in patients with coronary heart disease and heart failure has a certain correlation with the dose and frequency of administration.