摘要
目的系统评价托伐普坦单用或联合袢利尿剂改善心力衰竭(心衰)合并低钠血症的疗效并与袢利尿剂比较。方法计算机检索PubMed、EMbase、The Cochrane Library、WanFang Data、CBM和CNKI数据库,查找心衰患者治疗中托伐普坦单用或联合袢利尿剂和单用袢利尿剂的随机对照试验(RCT),检索时限均从建库至2020年2月。由2位评价员按纳入与排除标准独立筛选文献、提取相关信息等数据并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果共纳入16个RCT,包括1169例患者,其中观察组681例,对照组488例。Meta分析结果显示:观察组较对照组可降低BNP/NT-ProBNP水平(WMD=-917.80,95%CI:-957.98~-877.63,P<0.00001;WMD=-757.84,95%CI:-1238.37~-277.31,P=0.002)和体重(WMD=-2.81,95%CI:-5.00~-0.62,P=0.01),提高射血分数(WMD=6.35,95%CI:4.33~8.37,P<0.00001),血钠水平(WMD=6.49,95%CI:4.19~8.79,P<0.00001),改善心衰症状(WMD=5.29,95%CI:2.25~12.43,P=0.0001)和尿量(WMD=566.96,95%CI:502.20~631.73,P<0.00001)。未增加不良反应发生率(OR=1.66,95%CI:0.13~21.86,P=0.70),未减少住院时长(OR=1.66,95%CI:0.13~21.86,P=0.70)。结论托伐普坦单用或联合袢利尿剂较单用袢利尿剂能更好的改善心衰症状,改善心功能(降低BNP/NT-proBNP、提高左心室射血分数),降低体重、升高血钠。鉴于文献的数量和质量存在局限性,结论尚需进一步研究证实。
Objective To systematically review the curative effects of tolvaptan and tolvaptan combined with loop diuretics on heart failure(HF)accompanied by hyponatraemia and compared them with loop diuretics.Methods The databases of PubMed,EMbase,Cochrane Library,WanFang Data,CBM and CNKI were retrieved with computer for searching randomized controlled trials(RCT)related to treatment of HF accompanied by hyponatraemia with tolvaptan,tolvaptan combined with loop diuretics and loop diuretics from database establishment time to Feb.2020.The literatures were screened,data was extracted and bias risk was reviewed by 2 reviewers according to inclusion and exclusion criteria,and a Meta-analysis was conducted by using RevMan 5.3 software.Results There were totally 16 RCT included involved 1169 patients,and 681 in observation group and 488 in control group.The results of Meta-analysis showed that BNP/NT-proBNP(WMD=-917.80,95%CI:-957.98~-877.63,P<0.00001;WMD=-757.84,95%CI:-1238.37~-277.31,P=0.002)and body weight(WMD=-2.81,95%CI:-5.00~-0.62,P=0.01)were decreased,LVEF(WMD=6.35,95%CI:4.33~8.37,P<0.00001)and serum sodium level(WMD=6.49,95%CI:4.19~8.79,P<0.00001)were promoted,HF symptoms(WMD=5.29,95%CI:2.25~12.43,P=0.0001)and urine volume(WMD=566.96,95%CI:502.20~631.73,P<0.00001)were improved,and incidence rate of adverse reactions was no increased(OR=1.66,95%CI:0.13~21.86,P=0.70)and length of hospital stay was not reduced(OR=1.66,95%CI:0.13~21.86,P=0.70)in observation group compared with control group.Conclusion Tolvaptan combined with loop diuretics,compared with loop diuretics,can relieve better HF symptoms,improve heart function(reducing BNP/NTPro-BNP and promoting LVEF),reduce body weight and raise serum sodium level.As the limitation in quantity and quality of included literatures,the conclusion needs to be confirmed by further studies.
作者
黄梦洁
闫静
叶玲
刘永铭
Huang Mengjie;Yan Jing;Ye Ling;Liu Yongming(First Clinical Medical College,Lanzhou University,Lanzhou 730000,China;不详)
出处
《中国循证心血管医学杂志》
2021年第12期1413-1417,1429,共6页
Chinese Journal of Evidence-Based Cardiovascular Medicine
基金
国家临床重点专科建设项目(国卫医办函[2013]240号)。
关键词
托伐普坦
心衰
失代偿性心衰
低钠血症
META分析
Tolvaptan
Heart failure
Decompensated heart failure
Hyponatraemia
Meta-analysis
