■这项荟萃分析的目的是评估黄芪注射液(AI)对射血分数(HFmrEF)轻度降低的心力衰竭患者左心室重塑(LVR)的影响。
■从8个主要的英文和中文电子数据库中检索AI治疗HFmrEF的随机对照试验(RCT),直到2023年11月30日。评估纳入研究的方法学质量,采用Cochrane偏倚风险工具和改良的Jadad量表。采用Stata17.0软件进行统计分析,敏感性分析,以及对出版偏见的评估。
■确定了10个RCT,995名患者(男562名,女433名)。Meta分析显示,与常规治疗(CT)相比,AI显著改善了LVR,特别是增加左心室射血分数(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),左心室舒张末期内径(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),和左心室收缩末期直径(LVESD,MD=-3.42,95%CI:-4.90至-1.93,p<0.00001)。AI还改善了临床疗效(RR=4.62,95%CI:3.11-6.88,p<0.00001),减少的N末端脑钠肽前体(NT-proBNP,MD=-27.94,95%CI:-43.3至-12.36)水平,不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和Egger的测试显示没有明显的发表偏倚。
■系统评价和荟萃分析显示,AI与CT结合可改善HFmrEF患者的LVR,而不会增加不良事件。然而,由于证据有限,在解释结果时需要谨慎。未来需要高质量的RCT来支持这些结论。
■https://www.crd.约克。AC.英国/普华永道/,PROSPERO[CRD42022347248].
UNASSIGNED: 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).
UNASSIGNED: 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.
UNASSIGNED: 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, p < 0.00001), decreasing left ventricular end-diastolic volume (LVEDV, MD = -7.89, 95% CI: -11.13 to -4.64, p < 0.00001), left ventricular end-diastolic diameter (LVEDD, MD = -4.18, 95% CI: -5.79 to -2.56, p < 0.00001), left ventricular end-systolic volume (LVESV, MD = -8.11, 95% CI: -11.79 to -4.43, p < 0.00001), and left ventricular end-systolic diameter (LVESD, MD = -3.42, 95% CI: -4.90 to -1.93, p < 0.00001). AI also improved clinical efficacy (RR = 4.62, 95% CI: 3.11-6.88, p < 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, p = 0.35). Sensitivity analysis confirmed the reliability of the merged results, and Begg\'s and Egger\'s tests showed no significant publication bias.
UNASSIGNED: 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.
UNASSIGNED: https://www.crd.york.ac.uk/prospero/, PROSPERO [CRD42022347248].