标题：rhBNP联合左西孟坦治疗心肌梗死伴心力衰竭临床疗效的Meta分析

      作者：沈阳 1，陈岳招 2，张国恺 1，陈培锦 1    潮州市人民医院心血管内科 1、产科 2，广东 潮州 521000

      卷次： 2020年31卷6期

      【摘要】 目的 系统探讨重组人脑利钠肽(rhBNP)联合左西孟坦治疗心肌梗死合并心力衰竭患者的临床疗效。方法 计算机检索2005年1月至2019年6月中国知网(CNKI)、万方、维普数据库及Pubmed数据库，纳入 rhBNP联合左西孟坦治疗心肌梗死合并心力衰竭患者的随机对照试验(RCT)文献，应用ReviewManager5.0软件进行文献质量评价与Meta分析。结果 共纳入8篇RCT文献共800例患者；8篇RCT文献进行左室射血分数(LVEF)分析，Meta分析结果显示，采用 rhBNP联合左西孟坦治疗后LVEF水平较高，差异有显著统计学意义(OR=10.42，95%CI8.46~12.38，P<0.01)；漏斗图结果显示文献均匀分布于虚线两侧，大部分对称，小部分偏移；3篇RCT文献进行左室舒张末径(LVEDD)分析，Meta分析结果显示，采用 rhBNP联合左西孟坦治疗后LVEDD水平较低，差异具有显著统计学意义(OR=-5.62，95%CI-6.81~-4.43，P<0.01)；5篇RCT文献进行N末端脑钠肽(NT-proBNP)分析，Meta分析结果显示，采用 rhBNP联合左西孟坦治疗后NT-proBNP浓度较低，差异具有显著统计学意义(OR=-640.00，95%CI -1014.26~-265.75，P<0.01)；2篇RCT文献进行B型尿钠肽(BNP)分析，Meta分析结果显示，采用 rhBNP联合左西孟坦治疗后 BNP浓度较低，差异具有显著统计学意义(OR=-276.89，95%CI -288.89~-264.89，P<0.01)。结论 rhBNP联合左西孟坦治疗心肌梗死合并心力衰竭能提高患者的LVEF，降低LVEDD、NT-proBNP、BNP，其治疗效果确切，但由于文献质量普遍不高，确切结论仍需更高质量的文献来证实。
      【关键词】 重组人脑利钠肽；左西孟坦；心肌梗死合并心力衰竭；Meta分析
      【中图分类号】 R542.2+2 【文献标识码】 A 【文章编号】 1003—6350（2020）06—0789—05

Clinical efficacy of rhBNP combined with levosimendan in patients with myocardial infarction and heart failure:a meta-analysis.
SHEN Yang 1, CHEN Yue-zhao 2, ZHANG Guo-kai 1, CHEN Pei-jin 1. Department of CardiovascularMedicine 1, Department of Obstetrics 2, Chaozhou People's Hospital, Chaozhou 521000, Guangdong, CHINA
【Abstract】 Objective To investigate the clinical effect of rhBNP combined with levosimendan in patientswith myocardial infarction and heart failure. Methods From January 2005 to June 2019, CNKI, Wanfang, VIP, andPubMed databases were searched, and the randomized controlled trials (RCTs) of patients with myocardial infarctionand heart failure was collected. The literature quality evaluation and meta-analysis were carried out by using ReviewManager 5.0 software. Results Eight RCTs were included (involving 800 patients). The left ventricular ejection frac-tion (LVEF) levels were analyzed by meta-analysis. The results showed that the LVEF level was higher after rhBNPcombined with levosimendan treatment, and the difference was statistically significant (OR=10.42, 95% Cl8.46-12.38, P<0.01). Funnel chart showed that the literatures were evenly distributed on both sides of the dotted line,of which most were symmetrical and a small part was offset. Three RCTs were analyzed for left ventricular end diastol-ic diameter (LVEDD). The results showed that the level of LVEDD was lower after treatment with rhBNP and levosi-mendan, and the difference was statistically significant (OR=-5.62, 95% Cl -6.81 to -4.43, P<0.01). Five RCTs wereanalyzed for NT-proBNP. The results showed that the concentration of NT-proBNP was lower after rhBNP combinedwith levosimendan treatment (OR=-640.00, 95% Cl -1 014.26 to -265.75, P<0.01). Two RCTs were analyzed forB-type natriuretic peptide (BNP). The results showed that the concentration of BNP was lower after rhBNP combinedwith levosimendan, and the difference was statistically significant (OR=-276.89, 95%Cl -288.89 to -264.89, P<0.01).Conclusion Meta-analysis indicates that rhBNP combined with levosimendan is effective in patients with myocardialinfarction and heart failure. It can improve LVEF and reduce LVEDD, NT-proBNP, and BNP. However, due to the lowquality of the collected literature, higher quality literature are still needed to obtain accurate conclusion.
      【Key words】 rhBNP; Levosimendan; Myocardial infarction with heart failure; Meta-analysis·荟萃分析·doi:10.3969/j.issn.1003-6350.2020.06.032