重组人脑利钠肽对接受经皮冠状动脉介入治疗的急性心肌梗死患者的影响：一项系统评价和荟萃分析。

Effects of recombinant human brain natriuretic peptide in patients with acute myocardial infarction undergoing percutaneous coronary intervention: A systematic review and meta-analysis.

作者信息

Ning Cheng, Zheng Yawei, Li Jie, Liu Ming, Fang Zhuyuan

机构信息

Affiliated Hospital of Nanjing University of Chinese Medicine.

Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China.

出版信息

Medicine (Baltimore). 2020 Mar;99(11):e19479. doi: 10.1097/MD.0000000000019479.

DOI:10.1097/MD.0000000000019479

PMID:32176080

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7220387/

Abstract

OBJECTIVE

To systematically review the effect of recombinant human brain natriuretic peptide (rhBNP) on the cardiac function in patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI).

METHODS

PubMed, Web of Science, the Cochrane Library, Chinese Biomedical Database (CBD), and China National Knowledge Infrastructure (CNKI) were electronically searched to collect randomized controlled trials (RCTs) of traditional exercise for patients with AMI undergoing PCI from the beginning of the database inception to January 2019. Two reviewers independently screened the literature, extracted data, and evaluated the quality of included studies. Then, meta-analysis was performed using the RevMan 5.3 software.

RESULTS

A total of 16 RCTs and 1551 patients were included. The results of the meta-analysis showed that, compared with the control-treated patients, rhBNP-treated patients with AMI had an increased left ventricular ejection fraction (LVEF) of 3.34% ([MD = 3.34, 95% CI (0.39,6.29), P = .03]) 1 week postoperatively, 6.22% ([MD = 6.22, 95% CI (4.15,8.28), P < .00001]) 4 weeks postoperatively, 7.34% ([mean difference (MD) = 7.34, 95% CI (4.52, 10.16), P < .00001]) 12 weeks postoperatively, and 5.32% ([MD = 5.32, 95% CI (3.05, 7.59), P < .00001]) 24 weeks postoperatively. Moreover, the heart failure (HF) recurrence of rhBNP-treated patients with AMI 12 weeks postoperatively was 0.24 times that of the control-treated patients ([risk ratio (RR) = 0.24, 95% CI (0.06, 0.92), P = .04]), and the difference was statistically significant. At the same time, rhBNP-treated patients had decreased N-terminal pro-brain natriuretic peptide (NT-proBNP) (24 hours, 48 hours, 72 hours) and aldosterone (Ald) (24 hours, 72 hours, 168 hours) levels in comparison with the control-treated patients.

CONCLUSION

Current evidence shows that the application of rhBNP presents a greater clinical benefit to patients with AMI undergoing PCI. Due to the methodological bias in the included studies and small sample size, more high-quality studies are required to verify the study findings.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO (CRD42019126727).

摘要

目的

系统评价重组人脑利钠肽（rhBNP）对接受经皮冠状动脉介入治疗（PCI）的急性心肌梗死（AMI）患者心功能的影响。

方法

通过电子检索PubMed、Web of Science、Cochrane图书馆、中国生物医学数据库（CBD）和中国知网（CNKI），收集从数据库建立之初至2019年1月期间关于接受PCI的AMI患者进行传统运动的随机对照试验（RCT）。两名研究者独立筛选文献、提取数据并评估纳入研究的质量。然后，使用RevMan 5.3软件进行荟萃分析。

结果

共纳入16项RCT和1551例患者。荟萃分析结果显示，与接受对照治疗的患者相比，接受rhBNP治疗的AMI患者术后1周左心室射血分数（LVEF）增加3.34%（[平均差（MD）=3.34，95%可信区间（CI）（0.39，6.29），P = 0.03]），术后4周增加6.22%（[MD = 6.22，95% CI（4.15，8.28），P < 0.00001]），术后12周增加7.34%（[平均差（MD）=7.34，95% CI（4.52，10.16），P < 0.00001]），术后24周增加5.32%（[MD = 5.32，95% CI（3.05，7.59），P < 0.00001]）。此外，接受rhBNP治疗的AMI患者术后12周心力衰竭（HF）复发率是接受对照治疗患者的0.24倍（[风险比（RR）=0.24，95% CI（0.06，0.92），P = 0.04]），差异有统计学意义。同时，与接受对照治疗的患者相比，接受rhBNP治疗的患者N末端脑钠肽前体（NT-proBNP）（24小时、48小时、72小时）和醛固酮（Ald）（24小时、72小时、168小时）水平降低。