摘要
目的系统评价重组人脑利钠肽(rhBNP)治疗中国人群急性充血性心力衰竭的疗效及其不良反应。方法全面检索PubMed、EMbase、Cochrane图书馆(2009年第3期)、中国生物医学文献光盘数据库、中文科技期刊全文数据库和中国期刊全文数据库中关于在中国人群应用rhBNP治疗急性充血性心力衰竭的文献资料,由两名评价员按纳入与排除标准独立选择试验和提取资料,并按照Cochrane系统评价员手册的4条质量评价标准评价纳入文献的方法学质量,采用RevMan4.2.8软件进行Meta分析。结果共纳入19个随机对照试验,其中rhBNP组561例,对照病例551例,研究地点均在国内,研究质量均较高,各试验间具有基线可比性。Meta分析结果显示:左室射血分数rhBNP治疗组优于空白对照组[WMD=7.22,95%CI(3.15,11.291),P=0.0005]、心功能等级的改善rhBNP治疗组优于空白对照组[OR=5.48,95%C(I1.61,18.65),P=0.007]、硝酸甘油组[OR=3.60,95%C(I2.02,6.41),P<0.0001]及硝普钠组[OR=4.89,95%CI(2.59,9.24),P<0.00001];不良反应发生率rhBNP治疗组与空白对照组相比差异无统计学意义[OR=3.21,95%CI(0.12,85.20),P=0.49],但明显少于硝酸甘油组[OR=0.23,95%CI(0.11,0.47),P<0.0001]及硝普钠组[OR=0.30,95%CI(0.11,0.82),P=0.02]。敏感性分析显示结果稳定性较好。结论 rhBNP能有效改善中国人群心力衰竭患者的血流动力学及心功能等级,治疗量安全性好,推荐临床使用。
Objective To evaluate the efficacy of recombinant human brain natriuretic peptide （rhBNP） on Chinese patients with congestive heart failure by meta analysis.
Methods Both foreign language databases including PubMed, EMbase, The Cochrane Library （Issue 3, 2009） and Chinese databases involving CBM, VIP and CJFD were searched to identify randomized controlled trials （RCTs） that reported the effect of rhBNP on the heart function （left ventricular ejection fraction （LVEF） and the recent level of improvement in cardiac function） and its side effects of Chinese patients with congestive heart failure. Two reviewers assessed the quality of each trial and extracted data independently. The Cochrane Collaboration’s RevMan 4.2.8 software was used for statistical analysis.
Results Nineteen RCTs were included, all of which came from internal. The methodological quality of the included studies was good. The baseline data of each trial were comparable. The results of meta-analyses showed： （1） the improvement of LVEF was higher in the rhBNP group than that in the blank control group （WMD=7.22, 95%CI 3.15 to 11.291, P=0.000 5）. The level of improvement in cardiac function was better in the rhBNP group than those in the blank control group （OR=5.48, 95%CI 1.61 to 18.65, P=0.007）, the nitroglycerin group （OR=3.60, 95%CI 2.02 to 6.41, P〈0.000 1）, and the sodium nitroprusside group （OR=3.21, 95%CI 0.12 to 85.20, P=0.49）. The incidence of side effects was lower in the rhBNP group than that in the nitroglycerin group （OR=0.23, 95%CI 0.11 to 0.47, P〈0.000 1）, and the sodium nitroprusside group （OR=0.30, 95%CI 0.11 to 0.82, P=0.02）. Moreover, the results of sensitivity analysis were also consistent with the above findings.
Conclusion Recombinant human brain natriuretic peptide can effectively improve the hemodynamics and cardiac function level of Chinese population of patients with heart failure. The treatment doses are safe and tolerant, so it is recommended to clinical use.
出处
《中国循证医学杂志》
CSCD
2010年第5期570-577,共8页
Chinese Journal of Evidence-based Medicine
关键词
重组脑利钠肽
急性心力衰竭
心功能
随机对照试验
META分析
Brain natriuretic peptide
Acute heart failure
Cardiac function
Randomized controlled trial
Meta-analysis
