促红细胞生成素在慢性心功能不全合并贫血患者中的保护作用的meta分析

目的探讨促红细胞生成素(erythropoietin, EPO)对于慢性心动能不全(chronic heart failure, CHF)合并贫血患者的临床疗效及其安全性。方法 检索Embase、Medline至2013年7月为止的针对EPO与CHF进行临床疗效评估的相关文献。选择比较EPO与安慰剂或空白对照在CHF合并贫血患者的治疗效果的所有随机临床研究。结果总共有750例CHF合并贫血的患者接受EPO治疗3个月至1年并跟踪随访,这些患者包含在9个随机对照研究中。EPO的治疗可以显著降低CHF患者的住院周期(RR=0.47, CI: 0.32~0.70;P=0.0002)。CHF患者使用EPO治疗后虽不能降低其死亡风险 (RR=0.68, CI: 0.38~1.19;P=0.18),但也没有出现死亡率的升高。此外,CHF合并贫血的患者使用EPO治疗后可以显著改善血红蛋白(Hb),红细胞压积(HCT),脑利钠肽(BNP),运动能力,肾功能,心功能(NYHA)和左心室射血分数(LEVF)。结论 在CHF患者中,EPO治疗后有益作用明显,并没有出现死亡率的升高或更多不良事件的发生。这些结果支持在CHF合并贫血的患者中使用EPO进行治疗。

Efficacy and safety of erythropoietin in treatment of chronic heart failure complicated with anemia:a meta analysis

Objective To review the efficacy and safety of erythropoietin (EPO) in treatment of chronic heart failure (CHF) complicated with anemia by meta analysis.Methods EMBASE and MEDLINE database systems were retrieved for literatures on clinical efficacy of EPO in CHF patient complicated with anemia from their inception to July 2013. Randomized clinical trials on efficacy of EPO treatment versus placebo or conventional management for anemia patients with CHF were included. Results Nine randomized controlled studies involving 750 CHF patients with anemia receiving EPO treatment for 3 months to 1 year were identified. The study showed that EPO treatment significantly reduced the risk of hospitalization of patients with CHF (RR=0.47, CI: 0.32~0.70; P=0.0002).There was no reduction or elevation of mortality risk with EPO treatment for CHF patients (RR=0.68, CI:0.38 to 1.19; P=0.18). In addition, EPO therapy significantly improved hemoglobin (Hb), hematocrit (HCT), brain natriuretic peptide (BNP), exercise capacity, renal function, cardiac function (NYHA) and left ventricular ejection fraction (LEVF) in CHF patients with anemia. Conclusion EPO treatment is beneficial for CHF patients complicated with anemia, without increased mortality or adverse events.