补益强心片联合西药常规治疗慢性心力衰竭随机对照试验的Meta分析

目的]系统评价补益强心片联合西药常规治疗慢性心力衰竭的临床疗效与安全性。方法]计算机检索中国期刊全文数据库(CNKI)、维普中文期刊数据库(VIP)、万方期刊数据库(WanFang Data)、中国生物医学文献服务系统(SinoMed)、PubMed、Embase、Web of Science和The Cochrane Library(2018年3期),检索时间均从数据库建库至2018年3月,纳入补益强心片联合西药常规与西药常规对照治疗慢性心力衰竭的临床随机对照研究。采用Cochrane协作网的偏倚风险评估工具对纳入研究进行方法学质量评价。采用RevMan 5.3.5对疗效指标进行Meta分析。结果]共纳入7个随机对照试验,573例患者。Meta分析显示,补益强心片联合西药常规治疗慢性心力衰竭可以进一步增加患者左室射血分数(LVEF)MD=4.31,95%CI(3.73,4.90),P0.000 01],降低N末端B型利钠肽原(NTproBNP)水平SMD=-2.02,95%CI(-3.02,-1.02),P 0.0001],改善心功能(NYHA)RR=1.25,95%CI(1.09,1.43),P=0.001],降低Lee氏心衰积分MD=-1.09,95%CI(-1.36,-0.83),P0.000 01]和明尼苏达心衰生活质量评分(MLHFQ)MD=-10.90,95%CI(-13.12,-8.68),P0.000 01]。结论]纳入研究评价提示,补益强心片联合西药常规治疗慢性心力衰竭可进一步改善患者心功能、临床症状和生活质量且安全。由于纳入文献质量普遍较低,证据强度不足,上述结论仍需更多大样本、高质量试验研究证实。

A Meta-analysis on randomized controlled trials of routine Western medical treatment plus Buyi Qiangxin tablet for treating chronic heart failure

Objective] To systematically review the safety and efficacy of routine Western medical treatment plus Buyi Qiangxin tablets for treating patients with chronic heart failure(CHF).Methods] CNKI, VIP, Wanfang Data, SinoMed, PubMed, Embase, Web of Science and Cochrane Library(Issue 3, 2018) were retrieved by computer for papers on randomized control trials (RCTs) of treating CHF patients by routine Western medical treatment plus Buyi Qiangxin tablets, which were searched from inception to Mar. 2018. The quality of inclusive literatures was assessed by methods from Cochrane Handbook. Valid data were extracted and analyzed by Meta-analysis using RevMan 5.3.5 Software.Results] There were totally 7 trials and 573 cases in line with standard were included. Results of Meta-analysis showed, compared with the routine Western medical treatment group, additional use of Buyi Qiangxin Tablets could increase left ventricular ejection fraction (LVEF)MD=4.31,95%CI(3.73, 4.90), P<0.000 01], reduce the level of NT-proBNPSMD=-2.02, 95%CI (-3.02, -1.02),P<0.000 1], improve the cardiac function(NYHA)RR=1.25, 95%CI(1.09, 1.43),P=0.001],drop the score of Lee''s heart failureMD=-1.09,95%CI(-1.36, -0.83),P<0.000 01] and Minnesota life quality of heart failure questionnaires(MLHFQ)MD=-10.90, 95%CI(13.12, -8.68),P<0.000 01].Conclusion] Research result showed routine Western medical treatment plus Buyi Qiangxin tablets is safe and could further improve the cardiac function, clinical symptom and quality of life. However, due to the qualities of overall literatures are lower and lack of evidence, the conclusions are needed to be validated by more large samples of high quality clinical research.