慢性心力衰竭伴铁缺乏患者静脉补充铁剂有效性和安全性的meta分析

目的 用meta分析的方法评价慢性心力衰竭伴铁缺乏患者静脉补充铁剂的有效性和安全性。方法 收集国内外关于慢性心力衰竭伴铁缺乏患者静脉补充铁剂的随机对照临床试验（RCT），按照纳入与排除标准筛选文献，评价文献质量并提取有效数据，对其有效性和安全性进行meta分析。结果 共纳入相关英文研究5篇，其方法学质量较高，2篇文献的质量等级为A级，余为B级。Meta分析结果显示:①有效性:静脉注射铁剂能够改善患者血清铁蛋白［SMD=2.15，95%CI(0.84,3.45),P<0.01］、TSAT［MD=7.97,95%CI(5.71,10.23),P<0.01］、NYHA［MD=-0.56,95%CI(-0.97,-0.15),P<0.01］，减少因心力衰竭住院的人数［OR=0.27,95%CI(0.15,0.47),P<0.01］，但不能降低全因病死率［OR=0.83,95%CI(0.43,1.60),P>0.05］；②安全性:静脉注射铁剂未增加胃肠道不良反应［OR=1.11,95%CI(0.36,3.47),P>0.05］和总不良反应［OR=0.81,95%CI(0.26,2.46),P>0.05］。结论 静脉补充铁剂能够改善慢性心力衰竭伴铁缺乏患者的心衰症状，并具有良好的安全性，但不能改善临床预后。

Effects and safety of intravenous iron therapy in chronic heart failure with iron deficiency patients:a meta-analysis

AIM To review the effects and safety of intravenous iron therapy in chronic heart failure with iron deficiency patients. METHODS Related randomized controlled clinical trials (RCTs) related to intravenous iron therapy in chronic heart failure with iron deficiency patients were collected and selected according to inclusion and exclusion criteria. The effects and safety of intravenous iron were compared with meta-analysis. RESULTS The present investigation included a total of five trials. The quality of the included studies was high. The grade of two studies was A, and three studies were evaluated as B. Meta analysis showed that intravenous iron therapy can improve serum ferritin ［SMD=2.15, 95%CI(0.84,3.45), P=0.001］, TSAT ［MD=7.97, 95%CI(5.71,10.23), P<0.01］ and NYHA ［MD=-0.56, 95%CI(-0.97, -0.15), P<0.01］, reduce the numbers of hospitalizations for heart failure［OR=0.27,95%CI(0.15, 0.47), P<0.01］, but can not reduce all-cause mortality ［OR=0.83, 95%CI(0.43,1.60), P>0.05］. Intravenous iron therapy did not increase gastrointestinal adverse events ［OR=1.11, 95%CI(0.36, 3.47), P>0.05］ or drug-related adverse events ［OR=0.81, 95%CI(0.26,2.46), P>0.05］. CONCLUSION Intravenous iron therapy in chronic heart failure with iron-deficient patients is both effective in improving symptoms of heart failure and safe, but does not significantly improve clinical prognosis.