黄芪注射液对射血分数保留的心力衰竭患者左心室重构的影响：一项系统评价和荟萃分析
Effect of astragalus injection on left ventricular remodeling in HFmrEF: a systematic review and meta-analysis.
作者信息
Han Xu, Huang Lumei, Li Geng, Mou Xinglang, Cheng Caihong
机构信息
Department of Anorectal, Chongqing Changshou Traditional Chinese Medicine Hospital, Chongqing, China.
Department of Cardiology, Traditional Chinese Medicine Hospital Dianjiang Chongqing, Chongqing, China.
出版信息
Front Cardiovasc Med. 2024 Aug 6;11:1374114. doi: 10.3389/fcvm.2024.1374114. eCollection 2024.
OBJECTIVES
The aim of this meta-analysis is to evaluate the effect of astragalus injection (AI) on left ventricular remodeling (LVR) in patients with heart failure with mildly reduced ejection fraction (HFmrEF).
METHODS
The randomized controlled trials (RCTs) of AI in treating HFmrEF were retrieved from 8 major English and Chinese electronic databases, up until November 30, 2023. To evaluate the methodological quality of the included studies, the Cochrane bias risk tool and the Modified Jadad Scale were employed. Stata 17.0 software was utilized for statistical analysis, sensitivity analysis, and assessment of publication bias.
RESULTS
Ten RCTs with 995 patients (562 males and 433 females) were identified. Meta-analysis indicated that compared to conventional treatment (CT), AI significantly improved LVR, specifically increasing left ventricular ejection fraction (LVEF, MD = 4.56, 95% CI: 3.68-5.44, < 0.00001), decreasing left ventricular end-diastolic volume (LVEDV, MD = -7.89, 95% CI: -11.13 to -4.64, < 0.00001), left ventricular end-diastolic diameter (LVEDD, MD = -4.18, 95% CI: -5.79 to -2.56, < 0.00001), left ventricular end-systolic volume (LVESV, MD = -8.11, 95% CI: -11.79 to -4.43, < 0.00001), and left ventricular end-systolic diameter (LVESD, MD = -3.42, 95% CI: -4.90 to -1.93, < 0.00001). AI also improved clinical efficacy (RR = 4.62, 95% CI: 3.11-6.88, < 0.00001), reduced N-terminal pro-brain natriuretic peptide (NT-pro BNP, MD = -27.94, 95% CI: -43.3 to -12.36) level, without increasing the incidence of adverse reactions (RR = 1.60, 95% CI: 0.59-4.29, = 0.35). Sensitivity analysis confirmed the reliability of the merged results, and Begg's and Egger's tests showed no significant publication bias.
CONCLUSION
The systematic review and meta-analysis revealed that combining AI with CT improves LVR without increasing adverse events in HFmrEF patients. However, caution is needed in interpreting the results due to limited evidence. Future high-quality RCTs are needed to support these conclusions.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/, PROSPERO [CRD42022347248].
目的
本荟萃分析旨在评估黄芪注射液（AI）对射血分数轻度降低的心力衰竭（HFmrEF）患者左心室重构（LVR）的影响。
方法
从8个主要的英文和中文电子数据库中检索截至2023年11月30日AI治疗HFmrEF的随机对照试验（RCT）。为评估纳入研究的方法学质量，采用了Cochrane偏倚风险工具和改良Jadad量表。使用Stata 17.0软件进行统计分析、敏感性分析和发表偏倚评估。
结果
共纳入10项RCT，995例患者（男性562例，女性433例）。荟萃分析表明，与传统治疗（CT）相比，AI显著改善LVR，具体表现为提高左心室射血分数（LVEF，MD = 4.56，95%CI：3.68 - 5.44，P < 0.00001），降低左心室舒张末期容积（LVEDV，MD = -7.89，95%CI：-11.13至-4.64，P < 0.00001）、左心室舒张末期直径（LVEDD，MD = -4.18，95%CI：-5.79至-2.56，P < 0.00001）、左心室收缩末期容积（LVESV，MD = -8.11，95%CI：-11.79至-4.43，P < 0.00001）以及左心室收缩末期直径（LVESD，MD = -3.42，95%CI：-4.90至-1.93，P < 0.00001）。AI还提高了临床疗效（RR = 4.62，95%CI：3.11 - 6.88，P < 0.00001），降低N末端脑钠肽前体（NT-pro BNP，MD = -27.94，95%CI：-43.3至-12.36）水平，且未增加不良反应发生率（RR = 1.60，95%CI：0.59 - 4.29，P = 0.35）。敏感性分析证实了合并结果的可靠性，Begg检验和Egger检验均未显示出明显的发表偏倚。
结论
系统评价和荟萃分析显示，AI联合CT可改善HFmrEF患者的LVR且不增加不良事件。然而，由于证据有限，在解释结果时需谨慎。未来需要高质量的RCT来支持这些结论。
系统评价注册
https://www.crd.york.ac.uk/prospero/，PROSPERO [CRD42022347248]
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