重组人脑利钠肽治疗急性失代偿性心力衰竭安全性的Meta分析

doi:10.13481/j.1671-587x.20160426

摘要/Abstract

摘要：

目的：系统评价重组人脑利钠肽（rhBNP）治疗急性失代偿性心力衰竭（ADHF）的安全性，为其临床应用提供依据。方法：计算机检索PubMed、The Cochrane Library（2015年第1期）、EMBase、中国知网、维普数据库和万方数据库，由2名研究者分别对纳入文献进行数据提取和质量评价后，采用RevMan 5.1和Stata12.0软件进行Meta分析。结果：共纳入35个随机对照试验（RCT），12143例患者。Meta分析，在治疗ADHF过程中，rhBNP组与对照组患者1、3及6个月死亡率比较差异均无统计学意义（RR=1.01，95%CI：0.85~1.21，P=0.88；RR=0.89，95%CI：0.63~1.27，P=0.53；RR=0.97，95%CI：0.87~1.08，P=0.59），不良反应发生率比较差异也无统计学意义（RR=1.01，95%CI：0.71~1.43，P=0.97）；rhBNP组低血压发生率明显高于对照组（RR=1.42，95%CI：0.99~2.03，P=0.06）。结论：与多巴酚丁胺、扩血管药物和安慰剂比较，虽然rhBNP不改变ADHF患者的死亡率和不良反应发生率，但却增加了低血压的发生风险。临床上宜合理应用rhBNP，充分发挥其有效性，尽量规避低血压等事件的发生。

关键词: 重组人脑利钠肽, 急性失代偿性心力衰竭, 安全性, Meta分析

Abstract:

Objective: To evaluate the security of recombinant human brain natriuretic peptide(rhBNP) in the treatment of acute decompensated heart failure(ADHF),and to provide the basis for its application. Methods: Both foreign language databases including PubMed, The Cochrane Library(Issue 1,2015), EMBase and Chinese databases involving CNKI, VIP and Wanfang Data were searched. Two reviewers independently extracted the data, and assessed the quality;then the Meta-analysis was performed by using RevMan 5.1 software and Stata 12.0 software. Results: A total of 35 randomized controlled trials (RCTs) involving 12 143 patients were included. The results of Meta-analysis showed that compared with control group the 1-month mortality(RR=1.01,95%CI:0.85-1.21,P=0.88), 3-month mortality(RR=0.89,95%CI:0.63-1.27,P=0.53)and 6-month mortality(RR=0.97,95%CI:0.87-1.08,P=0.59) in rhBNP group had no statistical differences; no statistical difference was found in the incidence of side effects(RR=1.01,95%CI:0.71-1.43,P=0.97).The incidence of hypotension in rhBNP group was significantly higher than that in control group(RR=1.42,95%CI:0.99-2.03,P=0.06).Conclusion: Compared with dobutamine, vasodilator drugs and placebo, rhBNP doesn't change the mortality and incidence of adverse reactions of the patients with ADHF, but increases the risk of hypotension. Clinical application of rhBNP should be reasonable and its effectiveness should be exerted sufficiently, meanwhile, as much as possible to avoid hypotension, etc.

Key words: recombinant human brain natriuretic peptide, acute decompensated heart failure, security, Meta-analysis

中图分类号:

R541.6

祖冬妮, 赵明沂, 杜巍, 赵惟超, 贾书冰, 杨静玉, 项荣武. 重组人脑利钠肽治疗急性失代偿性心力衰竭安全性的Meta分析[J]. 吉林大学学报(医学版), 2016, 42(04): 768-776.

ZU Dongni, ZHAO Mingyi, DU Wei, ZHAO Weichao, JIA Shubing, YANG Jingyu, XIANG Rongwu. Meta-analysis on safety of recombinant human brain natriuretic peptide in treatment of acute decompensated heart failure[J]. Journal of Jilin University Medicine Edition, 2016, 42(04): 768-776.

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