芪苈强心胶囊治疗慢性心力衰竭疗效的Meta分析

目的对芪苈强心胶囊治疗慢性充血性心力衰竭的疗效进行系统评价。方法检索2013年12月31日之前发表的芪苈强心胶囊治疗慢性充血性心力衰竭的随机对照试验文献,按照纳入与排除标准纳入合格文献,采用Cochrane偏倚风险评估工具来对入选的16篇文献进行风险评估。由两位作者(评价员)独立从文本和表格中提取干预组和对照组治疗前后的评价指标及样本量。运用Rev Man5.2.7软件分析加权均数差及95%可信区间。结果共纳入16个研究试验,1422例研究对象,其中对照组699例,芪苈强心组723例。Meta分析显示在心力衰竭患者常规治疗的基础上加入芪苈强心胶囊后能够显著改善患者症状、提高临床综合疗效(RR=1.18,95%CI:1.13~1.24);增加左室射血分数(WMD=4.89,95%CI:3.03~6.75,P0.00001);降低血浆脑钠肽水平(WMD=95.86,95%CI:43.96~147.77,P0.00001);增加左室舒张末期内径(WMD=3.22,95%CI:1.64~4.80,P0.00001);有效增加患者的6分钟步行距离(WMD=41.44,95%CI:33.30~49.59,P0.00001);增加心排血量(WMD=0.22,95%CI:0.00~0.44,P=0.05);降低明尼苏达生活质量表积分(WMD=7.69,95%CI:4.39~10.99,P0.00001)。结论基于目前证据,芪苈强心胶囊治疗慢性充血性心力衰竭疗效良好。但纳入研究可能存在发表偏倚,对于芪苈强心胶囊治疗慢性心力衰竭的远期预后疗效还需更多的临床证据证实。

A Meta-analysis on curative effect of Qili Qiangxin Capsules on chronic heart failure

Objective To review the curative effect of Qili Qiangxin Capsules on chronic congestive heart failure （CHF）. Methods The randomized controlled trials （RCT） about Qili Qiangxin Capsules in chronic CHF treatment published before Dec. 31, 2013 were retrieved, and qualified RCT were chosen according to inclusion and exclusion criteria. All included 16 RCT documents were given risk reviewing by using Cochrane bias risk tool, and review index and sample volume were extracted from texts and tables by 2 independent reviewers in intervention group and control group before and after treatment. The weighting average difference and 95%CI were analyzed by using RevMan5.2.7 software. Results There were totally 16 RCT included involved 1422 cases （699 in control group and 723 in intervention group）. The results of Meta-analysis showed that Qili Qiangxin Capsules combining routine therapies relieved significantly symptoms, improved clinical efficacy （RR=1.18, 95%CI： 1.13-1.24）, increased LVEF （WMD=4.89, 95%CI： 3.03-6.75, P〈0.00001）, decreased BNP level （WMD=95.86, 95%CI：43.96-147.77, P=0.0003, P〈0.00001）, increased LVEDd （WMD=3.22, 95%CI：1.64-4.80, P〈0.00001）, increased effectively 6MWT （WMD=41.44, 95%CI：33.30-49.59, P〈0.00001）, increased CO （WMD=0.22, 95%CI：0.00-0.44, P=0.05）, and decreased the integral of Minnesota Table of Quality of Life （WMD=7.69, 95%CI： 4.39-10.99, P〈0.00001）. Conclusion The current evidence shows that Qili Qiangxin Capsules has good curative effect on chronic CHF. Because of included RCT with publishing bias, more clinical data are needed to confirm the long-term efficacy of Qiangxin Capsules.