中西医结合对慢性心力衰竭伴利尿剂抵抗疗效及客观指标影响的Meta分析

目的评估中西医结合治疗慢性心力衰竭伴利尿剂抵抗患者的疗效及对客观指标的影响。方法计算机检索中国知网、万方、维普、PubMed、Medline、EMbase等数据库,时限从建库至2020年2月,查找中西医结合治疗慢性心力衰竭伴利尿剂抵抗的随机对照临床研究,通过Cochrance系统评价手册对纳入文献做质量评价,使用ReviewManager5.3软件进行Meta分析。结果最终纳入研究15项,病例998例。与对照组比较,中西医结合治疗可明显提高心功能疗效[RR=1.32,95%CI(1.19,1.48),P<0.00001]、改善中医证候疗效[RR=1.30,95%CI(1.19,1.43),P<0.00001]、提高左心射血分数[SMD=0.74,95%CI(0.57,0.90),P<0.00001]、降低NT-ProBNP水平[SMD=-0.61,95%CI(-1.20,-0.77),P<0.00001]、增加24 h尿量[SMD=1.62,95%CI(0.95,2.29),P<0.00001]、增加6 min步行距离(6MWT)[SMD=2.08,95%CI(1.01,3.14),P<0.00001]、减少不良反应的发生[RR=0.10,95%CI(0.02,0.49),P<0.00001]。结论中西医结合治疗慢性心力衰竭伴利尿剂抵抗在心功能疗效、中医证候疗效、左心射血分数、NT-pro BNP水平、24 h尿量、6MWT、不良反应等方面优于单纯西医治疗。

Meta-analysis of the Effect and Objective Indexes of the Treatment of Chronic Heart Failure with Diuretic Resistance by the Combination of Traditional Chinese and Western Medicine

Objective:To evaluate the effects of integrated traditional Chinese and western medicine on the efficacy and objective indicators of patients with chronic heart failure with diuretic resistance.Methods:CNKI,WANFANG,VIP,PubMed,Medline,EMbase and other databases were retrieved by computer from inception to February 2020 for randomized controlled trials(RCTs)on the treatment of chronic heart failure with diuretic resistance with integrated traditional Chinese and Western medicine.The quality of the included literature was evaluated through the Cochrance evaluation manual,and the ReviewManager5.3 software was used for meta-analysis of the data.Results:Finally,a total of 15 studies were included,with 998 cases.Compared with the control group,integrated traditional Chinese and western medicine treatment could significantly improve the efficacy of cardiac function[RR=1.32,95%CI(1.19,1.48),P<0.00001],improve the efficacy of TCM syndromes[RR=1.30,95%CI(1.19,1.43),P<0.00001],increase left ventricular ejection fraction[SMD=0.74,95%CI(0.57,0.90),P<0.00001],decrease NT-ProBNP level[SMD=-0.61,95%CI(-1.20,-0.77),P<0.00001],increase 24 h urine output[SMD=1.62,95%CI(0.95,2.29),P<0.00001],increase patient′s 6-minute walking distance(6 MWT)[SMD=2.08,95%CI(1.01,3.14),P<0.00001],reduce the occurrence of adverse reactions[RR=0.10,95%CI(0.02,0.49),P<0.00001].Conclusion:Compared with western medicine treatment,the integrated traditional Chinese and western medicine method is more effective in treating chronic heart failure with diuretic resistance disease,such as cardiac function efficacy,TCM syndrome efficacy,left ventricular ejection fraction,NT-pro BNP level,24-hour urine output,6 MWT,and adverse reactions.