| 引用本文:耿彦婷1，宋庆桥1，胡元会1，刘瑞华1，张菀桐1，李偲偲2.利水类中药与利尿剂治疗心力衰竭的疗效与安全性—基于随机对照试验的系统评价[J].世界中医药,2016,(02):. |
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| 利水类中药与利尿剂治疗心力衰竭的疗效与安全性—基于随机对照试验的系统评价 |
| Efficacy and Safety of Promoting Urination Chinese Medicinals and Diuretics in Treating Heart Failure: A Systematic Review of Randomized Controlled Trials |
| 投稿时间：2015-08-17 |
| DOI：10.3969/j.issn.1673-7202.2016.02.042 |
| 中文关键词: 利水 中药 利尿剂 心力衰竭 系统评价 间接Meta分析 随机对照试验 |
| English Keywords:Promoting urination Chinese medicinals Diuretics Heart failure Systematic review Indirect meta-analysis Randomized controlled trails |
| 基金项目:国家自然科学基金面上项目(编号:81373833) |
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| 中文摘要: |
| 目的:系统评价利水类中药与利尿剂治疗心力衰竭的疗效及安全性。方法:计算机检索PubMed、Embase、Cochrane Library、CBM、CNKI、VIP及WanFang Data等数据库,依据纳入及排除标准纳入利水类中药与利尿剂治疗心力衰竭的随机临床对照试验,由两名研究者独立评价纳入研究的质量、提取数据并交叉核对,使用RevMan 5.2软件进行Meta分析,并采用加拿大卫生药品技术总署编写的ITC软件对两者实施间接比较。结果:Meta分析结果显示:在相同的常规治疗基础上,利水类中药临床疗效的总有效率高于利尿剂［RR=1.34,95%CI(1.13,1.60),P<0.05］。ITC分析结果提示利水类中药+常规治疗在治疗心力衰竭的临床疗效总有效率与利尿剂+常规治疗比较的差异并无统计学意义［RR=1.023,95%CI(0.789，1.327),P=0.975］。纳入文献中,利水类中药与利尿剂治疗在NYHA心功能分级、6 min步行试验及水肿减轻程度等的疗效评价方面,均仅有1篇文献报道提示利水类中药的疗效优势,超声心动图与BNP(或NT-proBNP)的疗效改善情况均无报道。3篇纳入文献报道了利尿剂与利水类中药治疗的相关不良反应,提示血钾异常等电解质紊乱不良反应的发生率以利尿剂治疗组更为明显。纳入的RCT均无严重不良事件的报道。结论:利水类中药联合常规治疗与利尿剂联合常规治疗的疗效比较因缺乏大样本、高质量的相关研究,目前尚无法得到较为可靠的结论。 |
| English Summary: |
| To evaluate the efficacy and safety of promoting urination Chinese medicinals and diuretics in heart failure based on systematic review of randomized controlled trails(RCT). Methods: RCT of promoting urination Chinese medicinals and diuretics in heart failure on PubMed, Embase, Cochrane Library, CBM, CNKI, VIP and WANFANG DATA etc. were searched according to the inclusion and exclusion criterias. And then, two reviewers independently accomplished the literature screening, data extraction, and assessment of the methodological quality of included studies. Meta-analysis was adopted via RevMan 5.2 software, and the indirect meta-analysis was achieved by Indirect Treatment Comparison (ITC) software. Results: Two RCTs on promoting urination Chinese medicinals versus diuretics involving 140 cases and three RCTs on diuretics versus controlled diuretics involving 228 cases were included. The results of the systematic review and meta-analysis showed that: on the basis of the same conventional therapy, the clinical efficacy of promoting urination Chinese medicinals was superior to diuretics［RR=1.34，95%CI(1.13,1.60)，P<0.05］, and the ITC outcomes showed that the differences were not statistically significant［RR=1.023，95%CI(0.789, 1.327)，P=0. 975］. There was one RCT reporting the curative advantages of promoting urination Chinese medicinals on NYHA cardiac functional grading, six minutes’ walking test and the degree of edema. Ultrasonic cardiogram and BNP (or NT-pro BNP) were not mentioned on the five included trails. The untoward effect such as electrolyte disturbance (potassium anomaly) was reported in three included trails with higher incidence in the diuretics group. There were no serious adverse events happened in both treatment groups. Conclusion: Comparing the curative efficacy between promoting urination Chinese medicinals and diuretics, reliable conclusion cannot be reached for lack of enough study samples and researches of high quality. |
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