Lv Ming-Yi, Deng Shu-Ling, Long Xiao-Feng
Department of Internal Medicine, ICU, Affiliated Zhongshan Hospital of Dalian University, Dalian, 116000, Liaoning Province, P.R. China.
Br J Clin Pharmacol. 2016 Jan;81(1):174-85. doi: 10.1111/bcp.12788. Epub 2015 Nov 28.
A meta-analysis was performed to compare the therapeutic outcomes in patients treated for heart failure (HF) with recombinant human brain natriuretic peptide (rhBNP) and dobutamine.
PubMed, Embase and the Chinese Biomedical Database were exhaustively searched to identify studies relevant to this meta-analysis. Eight cohort studies were found suitable for inclusion. Data regarding trial validity, methodological processes and clinical outcomes were extracted.
Patients treated with rhBNP showed statistically significant reduction of in-hospital mortality and re-admission rates compared with the dobutamine treated patient group (both P < 0.05). Further, the rhBNP treated patient group showed higher survival outcomes, compared with dobutamine treated patients, when the post-treatment follow-up period was longer than 6 months (P < 0.05). Stratified analysis based on ethnicity showed a dramatic decrease of in-hospital mortality among mixed race HF patients receiving rhBNP treatment (P < 0.05), but such decreases were not statistically significant in Asian and Caucasian populations (both P > 0.05). On the other hand, re-admission rates were significantly lower in rhBNP treated Caucasian and mixed race populations (both P < 0.05). Notably, in rhBNP treated group, dose levels of 0.015 and 0.03 incrementally lowered the re-admission rates, displaying dose effect, and the re-admission rates at both rhBNP doses were significantly lower than the dobutamine treated group (both P < 0.05).
Our meta-analysis results suggested that rhBNP therapy is associated with lower in-hospital mortality and re-admission rates in HF patients compared to the dobutamine regimen. Nevertheless, large scale prospective, randomized trials are necessary to confirm these findings.
进行一项荟萃分析,比较重组人脑利钠肽(rhBNP)和多巴酚丁胺治疗心力衰竭(HF)患者的疗效。
全面检索PubMed、Embase和中国生物医学数据库,以确定与该荟萃分析相关的研究。发现八项队列研究适合纳入。提取有关试验有效性、方法学过程和临床结果的数据。
与多巴酚丁胺治疗组相比,rhBNP治疗的患者住院死亡率和再入院率在统计学上显著降低(均P<0.05)。此外,当治疗后随访期超过6个月时,与多巴酚丁胺治疗的患者相比,rhBNP治疗组显示出更高的生存结果(P<0.05)。基于种族的分层分析显示,接受rhBNP治疗的混血HF患者住院死亡率显著降低(P<0.05),但在亚洲和白种人群中这种降低无统计学意义(均P>0.05)。另一方面,rhBNP治疗的白种人和混血人群再入院率显著较低(均P<0.05)。值得注意的是,在rhBNP治疗组中,0.015和0.03的剂量水平逐渐降低再入院率,显示出剂量效应,且两种rhBNP剂量下的再入院率均显著低于多巴酚丁胺治疗组(均P<0.05)。
我们的荟萃分析结果表明,与多巴酚丁胺方案相比,rhBNP治疗与HF患者较低的住院死亡率和再入院率相关。然而,需要大规模前瞻性随机试验来证实这些发现。