益气养阴活血利水方剂联合西医常规治疗慢性充血性心力衰竭的Meta分析

目的系统评价益气养阴活血利水方剂治疗慢性充血性心力衰竭(chronic heart failure,CHF)的临床疗效,为临床提供循证参考。方法通过计算机检索中国期刊全文数据库(CNKI)、万方数据库(Wanfang database)、中文科技期刊全文数据库(VIP)、中国生物医学文献数据库(CBM)、PubMed、EMbase、the Cochrane Library等中英文数据库,检索时间从各数据库建库至2018年5月31日,检索所有关于益气养阴活血利水方剂治疗CHF的随机对照试验(randomized controlled trial,RCT),并追寻纳入研究的参考文献。按照相关方法要求对检索出的文献进行评价并提取有效数据,采用RevMan5.3软件进行有关数据的Meta分析。结果本研究纳入8个RCT共722例患者。Meta分析结果显示,益气养阴活血利水方剂联合西医常规治疗可提高CHF治疗的显效率RR=1.28,95%CI(1.09,1.50),P=0.003],降低无效率RR=0.39,95%CI(0.26,0.57),P<0.00001]及脑钠肽水平(BNP)MD=-101.55,95%CI(-139.09,-64.01),P<0.00001],提高左室射血分数(LVEF)MD=7.28,95%CI(4.04,10.51),P<0.0001]、左心室舒张晚期与早期二尖瓣血流峰值速度比值(E/A)MD=0.17,95%CI(0.11,0.22),P<0.00001],而试验组与对照组有效率间差异无统计学意义RR=1.02,95%CI(0.86,1.21),P=0.81]。结论现有证据支持益气养阴活血利水方剂联合西医常规治疗CHF优于单纯西医常规治疗,但由于纳入研究的方法学和报告质量普遍一般,临床实验设计欠严谨规范,仍需开展多中心、大样本、高质量的RCT进行验证。

Tonifying Qi,Nourishing Yin and Activating Blood Circulation to Promote Diuresis Method Combined with Conventional Western Medicine in Treatment of Chronic Heart Failure: A Meta-Analysis of Clinical Controlled Trials

Objective To systematically assess the clinical effects of TCM with tonifying Qi,nourishing Yin,activating blood circulation to promote diuresis method in the treatment of chronic heart failure(CHF)and provide evidence for clinical reference.Methods We searched China Journal Full-text Database(CNKI),Wanfang database,Chinese PSTP(VIP),Chinese biomedical literature database(CBM)and PubMed,EMbase andthe Cochrane Library to collect randomized controlled trials(RCTs)and cross-over studies about using tonifying Qi,nourishing Yin,activating blood circulation to promote diuresis in the treatment of CHF from inception to January May 31 th,2018.According to the relevant methods,the retrieved literature was evaluated and the effective data was extracted,and Meta-analysis was performed by RevMan5.3 software.Results Totally 8 clinical RCTs were included in this study,involving 722 patients.The results of Meta-analysis showed thatthere were significant difference in markedly efficiency and inefficiency between two groupsRR=1.28,95%CI(1.09,1.50),P=0.003;RR=0.39,95%CI(0.26,0.57),P<0.00001],while not in efficiencyRR=1.02,95%CI(0.86,1.21),P=0.81].And as compared with western medicine alone,tonifying Qi,nourishing Yin and activating blood circulation to promote diuresis method based on the western medicine can increase ejection fractionMD=7.28,95%CI(4.04,10.51),P<0.0001],increased the peak flow rate ratio(E/A)in early and late of diastolic phaseMD=0.17,95%CI(0.11,0.22),P<0.00001],and reduced brain natriuretic peptide(BNP)after CHF treatmentMD=-101.55,95%CI(-139.09,-64.01),P<0.00001].Conclusion Current evidences support that applying tonifying Qi,nourishing Yin andactivating blood circulation to promote diuresis method based on western medicine for chronic heart failure is better than routine treatment.Nevertheless,due to the uneven quality in methodology and the reportsas well as inexact design of clinical trials,more RCTs with multi-center,large sample size and high quality sample are sill required to verify the efficacy.