2022 年第 8 期 第 17 卷

真武汤合葶苈大枣泻肺汤加减联合常规西药治疗心力衰竭临床效果及安全性的Meta分析

A Meta-analysis of clinical efficacy and safety of Zhenwu decoction and Tingli Dazao Xiefei decoction combined with routine western medicine on heart failure

作者：王滋张振民尚菊菊

英文作者：Wang Zi Zhang Zhenmin Shang Juju

单位：首都医科大学附属北京中医医院心血管内科，北京100010

英文单位：Department of Cardiovascular Medicine Beijing Hospital of Traditional Chinese Medicine Capital Medical University Beijing 100010 China

关键词：心力衰竭；真武汤；葶苈大枣泻肺汤；Meta分析 

英文关键词：Heartfailure;Zhenwudecoction;TingliDazaoXiefeidecoction;Meta-analysis

• 摘要：

• 目的 应用Meta分析的方法探讨真武汤合葶苈大枣泻肺汤加减联合常规西药治疗心力衰竭的临床效果及安全性。方法 计算机检索中国学术期刊全文数据库、万方数据库、PubMed、Cochrane library，收集真武汤合葶苈大枣泻肺汤加减联合常规西药（观察组）对比单纯常规西药（对照组）治疗心力衰竭的临床随机对照试验，检索时间为建库起至2022年3月15日，采用Review Manager 5.3软件进行Meta分析。结果 最终纳入12项临床随机对照研究，共749例患者。Meta分析结果显示，观察组治疗后的血N末端B型脑钠肽前体（NT-proBNP）水平低于对照组（标准化均数差=-2.06，95%置信区间：-2.36～-1.75，Z=13.35，P＜0.01），左心室射血分数（LVEF）水平、临床疗效（总有效率）、中医证候疗效、生活质量高于/优于对照组，差异均有统计学意义（均P＜0.01）。2组患者治疗后血B型脑钠肽水平、不良反应发生率差异均无统计学意义（P=0.15、0.02）。结论 真武汤合葶苈大枣泻肺汤加减联合常规西药与单纯西药治疗相比，能够提高心力衰竭患者LVEF水平，降低血NT-proBNP水平，提高临床总有效率、中医证候疗效，改善患者生活质量，且临床应用安全性良好。

• Objective To evaluate the clinical efficacy and safety of Zhenwu decoction and Tingli Dazao Xiefei decoction combined with routine western medicine on heart failure through Meta-analysis. Methods Clinical randomized controlled trials were retrieved from China Science Periodical Database, Wanfang Data, PubMed and Cochrane Library, which about Zhenwu decoction and Tingli Dazao Xiefei decoction combined with routine western medicine (observation group) versus routine western medicine only (control group) in the treatment of heart failure were collected from databases founded to March 15, 2022. Review Manager 5.3 software was used for Meta-analysis. Results A total of 12 clinical randomized controlled trials were enrolled, including 749 patients. Meta-analysis showed that the serum level of N-terminal pro-brain natriuretic peptide (NT-proBNP) in the observation group was lower than that in the control group after treatment（standardized mean difference=-2.06，95% confidence interval：-2.36 to -1.75，Z=13.35，P＜0.01）. The level of left ventricular ejection fraction (LVEF)，clinical efficacy (total clinical effective rate), curative efficacy of traditional Chinese medicine syndrome and quality of life in the observation group were higher/better than those in the control group (all P＜0.01). There were significant differences in the serum level of brain natriuretic peptide and incidence of adverse effects between the two groups (P=0.15, 0.02). Conclusions  Compared with routine western medicine, Zhenwu decoction and Tingli Dazao Xiefei decoction combined with routine western medicine can improve the LVEF in patients with heart failure，which even can reduce the serum level of NT-proBNP, improve the total clinical effective rate, curative efficacy of traditional Chinese medicine syndrome and quality of life, and are safe in clinical application.