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

摘要

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.%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。