法舒地尔辅助治疗慢性心力衰竭患者临床效果的Meta分析
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摘要
目的运用Meta分析方法评价法舒地尔辅助治疗慢性心力衰竭患者的临床效果。方法计算机检索中国期刊全文数据库(CNKI)、中文科技期刊全文数据库(VIP)、万方数字化期刊全文库、Pubmed和Cochrane library,对纳入的随机对照试验文献进行质量评价,并采用Rev Man 5.2软件进行Meta分析。结果共纳入15篇随机对照试验,共1353例患者。Meta分析结果显示,与常规治疗组相比,法舒地尔加用常规治疗可有效提高慢性心力衰竭患者的临床疗效(RR=1.16,95%CI:1.10~1.23,P<0.01),延长6分钟步行试验距离(WMD=49.02,95%CI:42.85~55.2,P<0.01),提升左室射血分数(WMD=0.06,95%CI:0.05~0.07,P<0.01),以及缩小左室舒张末期内径(WMD=-3.01,95%CI:-4.18~-1.84,P<0.01)和左心室收缩末期内径(WMD=-3.74,95%CI:-4.88~-2.60,P<0.01)。结论法舒地尔辅助治疗慢性心力衰竭患者可改善心功能,并能抑制左室重塑,提高临床疗效,但仍需开展高质量的药物临床试验。
Objective Using meta-analysis to evaluate the clinical effect of fasudil therapy in patients with chronic heart failure. Methods We searched articles in China Journal Full-text Database(CNKI), Chinese PSTP(VIP), Wanfang database, Pubmed and Cochrane library. The included randomized controlled trial literature was quality assessed and meta-analyzed using Rev Man 5.2 software. Results A total of 15 randomized controlled trials involving a total of 1353 patients were included. The results of Meta-analysis showed that, compared with the conventional treatment group, fasudil plus routine treatment can effectively improve the clinical efficacy of patients with chronic heart failure [RR=1.16,95%CI:1.10~1.23,P<0.01], prolonged 6-minute walk distance [WMD=49.02,95%CI:42.85~55.2,P<0.01], improve left ventricular ejection fraction [WMD=0.06,95%CI:0.05~0.07,P<0.01], reduce left ventricular end-diastolic diameter [WMD=-3.01,95%CI:-4.18~-1.84,P<0.01] and left ventricular end-systolic diameter [WMD=-3.74,95%CI:-4.88~-2.60,P<0.01]. ConclusionFasudil therapy can improve the cardiac function in patients with chronic heart failure, and can inhibit left ventricular remodeling, improve clinical efficacy, but still need to carry out high quality drug clinical trials.
Objective Using meta-analysis to evaluate the clinical effect of fasudil therapy in patients with chronic heart failure. Methods We searched articles in China Journal Full-text Database(CNKI), Chinese PSTP(VIP), Wanfang database, Pubmed and Cochrane library. The included randomized controlled trial literature was quality assessed and meta-analyzed using Rev Man 5.2 software. Results A total of 15 randomized controlled trials involving a total of 1353 patients were included. The results of Meta-analysis showed that, compared with the conventional treatment group, fasudil plus routine treatment can effectively improve the clinical efficacy of patients with chronic heart failure [RR=1.16,95%CI:1.10~1.23,P<0.01], prolonged 6-minute walk distance [WMD=49.02,95%CI:42.85~55.2,P<0.01], improve left ventricular ejection fraction [WMD=0.06,95%CI:0.05~0.07,P<0.01], reduce left ventricular end-diastolic diameter [WMD=-3.01,95%CI:-4.18~-1.84,P<0.01] and left ventricular end-systolic diameter [WMD=-3.74,95%CI:-4.88~-2.60,P<0.01]. ConclusionFasudil therapy can improve the cardiac function in patients with chronic heart failure, and can inhibit left ventricular remodeling, improve clinical efficacy, but still need to carry out high quality drug clinical trials.
引文
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[2]李娜,孔一慧,李为民.Rho激酶抑制剂与心力衰竭关系的研究进展[J].心血管病学进展,2009,30(4):673-6.
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[6]卢丽君,曹敏,沈艳,等.法舒地尔治疗慢性心力衰竭临床观察[J].中国医院药学杂志,2017,37(9):862-5.
[7]冯金花.法舒地尔对冠心病心力衰竭患者心室重塑状态的影响观察[J].医药前沿,2016,6(25):148-9.
[8]刘克强,黄良顺,胡雨平.法舒地尔治疗冠心病心力衰竭临床疗效观察[J].中国现代医生,2012,50(24):56-7.
[9]周磊,张小勇,吕远.盐酸法舒地尔治疗缺血性心肌病心力衰竭的研究[J].中国社区医师:医学专业,2012,14(14):87-8.
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[11]姬洪涛.盐酸法舒地尔在治疗冠心病心力衰竭中的临床疗效[J].中国社区医师:医学专业,2011,13(30):77.
[12]张晓璐,王晓艳,刘永.法舒地尔辅助治疗冠心病慢性心力衰竭41例效果观察[J].山东医药,2011,51(23):37-8.
[13]张静,辜锦川.法舒地尔对心力衰竭患者心室结构的改善作用及临床疗效研究[J].心血管康复医学杂志,2017,26(4):431-4.
[14]李晓峰,张玉梅.法舒地尔治疗冠心病并心力衰竭的疗效观察[J].疑难病杂志,2012,11(2):129-30.
[15]石伟利.盐酸法舒地尔对冠心病心力衰竭患者心室重构和心功能的影响[J].内蒙古医学杂志,2010,42(2):183-5.
[16]罗瑞英,刘丽梅,强剑颖,等.超声心动图评价Rho激酶抑制剂治疗缺血性心肌病心力衰竭[J].中西医结合心脑血管病杂志,2010,08(9):1029-30.
[17]袁洪文.盐酸法舒地尔治疗缺血性心肌病心力衰竭[J].现代中西医结合杂志,2009,18(6):600-1.
[18]靳凤琳,张斌,王芳.盐酸法舒地尔对冠心病心力衰竭的临床疗效观察[J].中外医疗,2012,31(23):102.
[19]韩凌,陈金良,刘志明,等.盐酸法舒地尔治疗冠心病心力衰竭的临床疗效[J].山西医药杂志,2010,39(17):867-8.
[20]顾顺忠,王世亚,丁宏胜,等.法舒地尔对冠心病心力衰竭患者BNP及hs-CRP的影响[J].中西医结合心脑血管病杂志,2015(16):1857-9.
[21]中华医学会心血管病学分会.慢性心力衰竭诊断治疗指南[J].中华心血管病杂志,2007,35(12):1076-95.
[22]曾宪涛,包翠萍,曹世义,等.Meta分析系列之三:随机对照试验的质量评价工具[J].中国循证心血管医学杂志,2012,04(3):183-5.
[23]曾宪涛,Joey S.W.Kwong,田国祥,等.Meta分析系列之二:Meta分析的软件[J].中国循证心血管医学杂志,2012,04(2):89-91.
[24]Shimizu T,Liao JK.Rho kinases and cardiac remodeling[J].Circ J,2016,80(7):1491-1498.
[25]虞莹珺,张凤如.新型心力衰竭药物的当代现状[J].心肺血管病杂志,2016,35(1):71-4.
[26]Zhou Q,Gensch C,Liao JK.Rho-associated coiled-coil-forming kinases(ROCKs):Potential targets for the treatment of atherosclerosis and vascular disease[J].Trends Pharmacol Sci,2011,32(3):167-73.
[27]Sawada N,Liao JK.Rho/Rho-associated coiled-coil forming kinase pathway as therapeutic targets for statins in atherosclerosis[J].Antioxid Redox Signal,2014,20(8):1251-67.
[28]Feng Y,Lo Grasso PV,Defert O,et al.Rho Kinase(ROCK)inhibitors and their therapeutic Potential[J].J Med Chem,2016,59(6):2269-300.
[29]Shibuya M,Suzuki Y,Sugita K,et al.Effect of AT877 on cerebral vasospasm after aneurysmal subarachnoid hemorrhage:Results of a prospective placebo-controlled double-blind trial[J].J Neurosurg,1992,76(4):571-7.
[30]Liu GJ,Wang ZJ,Wang YF,et al.Systematic assessment and metaanalysis of the efficacy and safety of fasudil in the treatment of cerebral vasospasm in patients with subarachnoid hemorrhage[J].Eur J Clin Pharmacol,2012,68(2):131-9.
[31]Shi J,Wei L.Rho kinases in cardiovascular physiology and pathophysiology:the effect of fasudil[J].J Cardiovasc Pharmacol,2013,62(4):341-54.
[2]李娜,孔一慧,李为民.Rho激酶抑制剂与心力衰竭关系的研究进展[J].心血管病学进展,2009,30(4):673-6.
[3]Funakoshi Y,Ichiki T,Shimokawa H,et al.Rho-kinase mediates angiotensin II-induced monocyte chemoattractant protein-1expression in rat vascular smooth muscle cells[J].Hypertension,2001,38(1):100-4.
[4]Takeda K,Ichiki T,Tokunou T,et al.Critical role of Rho-kinase and MEK/ERK pathways for angiotensin II-induced plasminogen activator inhibitor type-1 gene expression[J].Arteriosclerosis Thrombosis and Vascular Biology,2001,21(5):868-73.
[5]Sauzeau V,Mellionnec EL,Bertoglio J,et al.Human urotensin II–Induced contraction and arterial smooth muscle cell proliferation are mediated by rho A and rho-kinase[J].Circulation Research,2001,88(11):1102-4.
[6]卢丽君,曹敏,沈艳,等.法舒地尔治疗慢性心力衰竭临床观察[J].中国医院药学杂志,2017,37(9):862-5.
[7]冯金花.法舒地尔对冠心病心力衰竭患者心室重塑状态的影响观察[J].医药前沿,2016,6(25):148-9.
[8]刘克强,黄良顺,胡雨平.法舒地尔治疗冠心病心力衰竭临床疗效观察[J].中国现代医生,2012,50(24):56-7.
[9]周磊,张小勇,吕远.盐酸法舒地尔治疗缺血性心肌病心力衰竭的研究[J].中国社区医师:医学专业,2012,14(14):87-8.
[10]周继旺,季乃军.法舒地尔治疗冠心病心力衰竭的疗效观察[J].海峡药学,2010,22(1):107-9.
[11]姬洪涛.盐酸法舒地尔在治疗冠心病心力衰竭中的临床疗效[J].中国社区医师:医学专业,2011,13(30):77.
[12]张晓璐,王晓艳,刘永.法舒地尔辅助治疗冠心病慢性心力衰竭41例效果观察[J].山东医药,2011,51(23):37-8.
[13]张静,辜锦川.法舒地尔对心力衰竭患者心室结构的改善作用及临床疗效研究[J].心血管康复医学杂志,2017,26(4):431-4.
[14]李晓峰,张玉梅.法舒地尔治疗冠心病并心力衰竭的疗效观察[J].疑难病杂志,2012,11(2):129-30.
[15]石伟利.盐酸法舒地尔对冠心病心力衰竭患者心室重构和心功能的影响[J].内蒙古医学杂志,2010,42(2):183-5.
[16]罗瑞英,刘丽梅,强剑颖,等.超声心动图评价Rho激酶抑制剂治疗缺血性心肌病心力衰竭[J].中西医结合心脑血管病杂志,2010,08(9):1029-30.
[17]袁洪文.盐酸法舒地尔治疗缺血性心肌病心力衰竭[J].现代中西医结合杂志,2009,18(6):600-1.
[18]靳凤琳,张斌,王芳.盐酸法舒地尔对冠心病心力衰竭的临床疗效观察[J].中外医疗,2012,31(23):102.
[19]韩凌,陈金良,刘志明,等.盐酸法舒地尔治疗冠心病心力衰竭的临床疗效[J].山西医药杂志,2010,39(17):867-8.
[20]顾顺忠,王世亚,丁宏胜,等.法舒地尔对冠心病心力衰竭患者BNP及hs-CRP的影响[J].中西医结合心脑血管病杂志,2015(16):1857-9.
[21]中华医学会心血管病学分会.慢性心力衰竭诊断治疗指南[J].中华心血管病杂志,2007,35(12):1076-95.
[22]曾宪涛,包翠萍,曹世义,等.Meta分析系列之三:随机对照试验的质量评价工具[J].中国循证心血管医学杂志,2012,04(3):183-5.
[23]曾宪涛,Joey S.W.Kwong,田国祥,等.Meta分析系列之二:Meta分析的软件[J].中国循证心血管医学杂志,2012,04(2):89-91.
[24]Shimizu T,Liao JK.Rho kinases and cardiac remodeling[J].Circ J,2016,80(7):1491-1498.
[25]虞莹珺,张凤如.新型心力衰竭药物的当代现状[J].心肺血管病杂志,2016,35(1):71-4.
[26]Zhou Q,Gensch C,Liao JK.Rho-associated coiled-coil-forming kinases(ROCKs):Potential targets for the treatment of atherosclerosis and vascular disease[J].Trends Pharmacol Sci,2011,32(3):167-73.
[27]Sawada N,Liao JK.Rho/Rho-associated coiled-coil forming kinase pathway as therapeutic targets for statins in atherosclerosis[J].Antioxid Redox Signal,2014,20(8):1251-67.
[28]Feng Y,Lo Grasso PV,Defert O,et al.Rho Kinase(ROCK)inhibitors and their therapeutic Potential[J].J Med Chem,2016,59(6):2269-300.
[29]Shibuya M,Suzuki Y,Sugita K,et al.Effect of AT877 on cerebral vasospasm after aneurysmal subarachnoid hemorrhage:Results of a prospective placebo-controlled double-blind trial[J].J Neurosurg,1992,76(4):571-7.
[30]Liu GJ,Wang ZJ,Wang YF,et al.Systematic assessment and metaanalysis of the efficacy and safety of fasudil in the treatment of cerebral vasospasm in patients with subarachnoid hemorrhage[J].Eur J Clin Pharmacol,2012,68(2):131-9.
[31]Shi J,Wei L.Rho kinases in cardiovascular physiology and pathophysiology:the effect of fasudil[J].J Cardiovasc Pharmacol,2013,62(4):341-54.