参芪扶正注射液防治蒽环类药物心脏毒性的Meta分析
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摘要
目的探讨参芪扶正注射液对蒽环类药物诱导的心脏毒性的预防作用。方法通过计算机检索Pubmed、Embase、Cochrane Library、CNKI、万方、维普等数据库,检索时间均从建库至2018年9月30日。由2位研究者严格按照纳入标准与排除标准独立筛选相关文献、提取资料和评价纳入研究的方法学质量,采用RevMan 5.3软件进行Meta分析。结果与对照组相比,使用参芪扶正注射液的试验组能显著减少左心室射血分数的降低幅度[标准均数差(SMD)=0.69,95%CI(0.22,1.16),P=0.004],降低B型脑钠肽的升高幅度[SMD=-2.32,95%CI(-3.03,-1.60),P<0.000 01],减少心电图异常的发生率[相对危险度(RR)=0.47,95%CI(0.33,0.67),P<0.000 1],降低心电图ST-T改变的发生率[RR=0.54,95%CI(0.41,0.72),P<0.000 1],差异均有统计学意义(P<0.05)。结论参芪扶正注射液可改善蒽环类药物化疗患者的心功能,以及减少心电图异常和ST-T改变的发生率,对应用蒽环类药物的肿瘤患者有心脏保护作用。
Objective To explore the preventive effect of Shenqi Fuzheng Injection for cardiotoxicity induced by anthracyclines.Methods The databases of PubMed,EMBASE,Cochrane Library,CNKI,Wanfang Data and VIP were retrieved by computer.The retrieval time was from the database establishment to September 30,2018.Two researchers independently screened the related literature according to the inclusion and exclusion standards,extracted the data and evaluated the methodologic quality of included studies.The RevMan5.3 software was used for conducting the Meta analysis.Results Compared with the control group,using Shenqi Fuzheng Injection in the experimental group could significantly decrease the reduction range of LVEF[standard mean deviation(SMD)=0.69,95%CI(0.22,1.16),P=0.004],reduced BNP [SMD=-2.32,95%CI(-3.03,-1.60),P<0.000 01],decreased the incidence rate of abnormal ECG [relative risk(RR)=0.47,95%CI(0.33,0.67),P<0.000 1]and occurrence rate of ST-T changes[RR=0.54,95%CI(0.41,0.72),P<0.000 1],and the differences were statistically significant(P<0.05).Conclusion Shenqi Fuzheng Injection can improve the cardiac function as well as the incidence rate of abnormal electrocardiogram and STT changes in the patients with anthracycline chemotherapy,and has the cardioprotection effect in tumor patients treated with anthracyclines.
Objective To explore the preventive effect of Shenqi Fuzheng Injection for cardiotoxicity induced by anthracyclines.Methods The databases of PubMed,EMBASE,Cochrane Library,CNKI,Wanfang Data and VIP were retrieved by computer.The retrieval time was from the database establishment to September 30,2018.Two researchers independently screened the related literature according to the inclusion and exclusion standards,extracted the data and evaluated the methodologic quality of included studies.The RevMan5.3 software was used for conducting the Meta analysis.Results Compared with the control group,using Shenqi Fuzheng Injection in the experimental group could significantly decrease the reduction range of LVEF[standard mean deviation(SMD)=0.69,95%CI(0.22,1.16),P=0.004],reduced BNP [SMD=-2.32,95%CI(-3.03,-1.60),P<0.000 01],decreased the incidence rate of abnormal ECG [relative risk(RR)=0.47,95%CI(0.33,0.67),P<0.000 1]and occurrence rate of ST-T changes[RR=0.54,95%CI(0.41,0.72),P<0.000 1],and the differences were statistically significant(P<0.05).Conclusion Shenqi Fuzheng Injection can improve the cardiac function as well as the incidence rate of abnormal electrocardiogram and STT changes in the patients with anthracycline chemotherapy,and has the cardioprotection effect in tumor patients treated with anthracyclines.
引文
[1]MCGOWAN J V,CHUNG R,MAULIK A,et al.Anthracycline chemotherapy and cardiotoxicity[J].Cardiovasc Drug Ther,2017,31(1):63-75.
[2]陈恕之,祁小明,钱德元,等.参芪扶正注射液预防蒽环类药物心脏毒性临床观察[J].实用临床医药杂志,2017,21(9):163-164.
[3]王兰荣,王海存,曹旸.参芪扶正注射液辅助治疗乳腺癌60例疗效观察[J].中华肿瘤防治杂志,2016,23(2):105-106.
[4]蔡辉,桂金川,方向东,等.应用参芪扶正液降低蒽环类化疗药物的心脏毒性作用[J].四川医学,2015,36(11):1565-1567.
[5]巩晓红,耿旭红,尹希,等.二维应变超声心动图评价乳腺癌患者表阿霉素化疗联合参芪注射液治疗后左心室收缩功能[J].临床荟萃,2014,29(12):1397-1399.
[6]王庆月.芪扶正注射液预防蒽环类药物相关心脏毒性反应30例临床观察[J].中国医药指南,2012,10(15):273-274.
[7]崔彦芝,张思洁,韩亚光,等.参芪扶正注射液预防蒽环类药物心脏毒性的临床观察[J].河北医药,2011,33(11):1685-1686.
[8]顾晓怡,姜藻,董丽钧.参芪扶正液抗蒽环类化疗药物所致心脏毒性的作用[J].东南大学学报(医学版),2008,49(5):375-377.
[9]宁亚利,姚淑莲,李东辉,等.参芪扶正注射液对表阿霉素心脏毒性保护作用的临床研究[J].陕西中医,2008,29(2):159-161.
[10]FENG Y Y,YANG Z J.Clinical application of the heart rate deceleration capacity test to predict epirubicin-induced cardiotoxicity[J].J Cardiovasc Pharmacol,2015,66(4):371-375.
[11]CARVALHO F S,BURGEIRO A,GARCIA R,et al.Doxorubicin-Induced cardiotoxicity:from bioenergetic failure and cell death to cardiomyopathy[J].Med Res Rev,2014,34(1):106-135.
[12]何蓉,李俊峰,薛成.慢性心力衰竭患者血清氨基末端脑钠肽前体及肌钙蛋白T的检测意义[J].检验医学与临床,2015,12(21):3204-3206.
[13]刘艳,王辉.肌钙蛋白I与肌酸激酶同工酶在老年人急性心肌梗死中的应用价值[J].检验医学与临床,2015,12(6):732-733,736.
[14]金之湲,胡燕华.超声心动图评估蒽环类化疗药物心脏毒性的临床研究进展[J].内蒙古医科大学学报,2016,38(3):255-258,263.
[15]赵爱群.动态心电图诊断无症状性心肌缺血的临床效果观察[J].检验医学与临床,2013,10(15):2021-2022.
[16]王建智,刘庆安,王建国.黄芪注射液拮抗阿霉素致小鼠心脏毒性的作用[J].第四军医大学学报,2006,27(4):366-366.
[17]王振富,钟灵,文德鉴.参芪扶正注射液对心肌缺血/再灌注损伤的保护作用[J].中国应用生理学杂志,2013,29(5):409-410.
[18]蔡英敏,胡海涛,马小亚,等.参芪扶正注射液对老龄大鼠脑缺血再灌注损伤的保护作用[J].中国中医药现代远程教育,2014,12(7):147-149.
[19]杨艳,胡喜田.参芪扶正注射液对联合放化疗患者心肌损伤的保护作用[J].现代中西医结合杂志,2018,27(9):963-966.
[20]刘其勇,卢凌珊,王际军,等.参芪扶正注射液治疗慢性心力衰竭研究进展[J].中国药物经济学,2014,12(4):287-288.
[21]王凯欢,吴嘉瑞,段笑娇,等.基于Meta分析的参芪扶正注射剂治疗慢性心力衰竭临床评价研究[J].药物流行病学杂志,2018,27(1):27-32.
[2]陈恕之,祁小明,钱德元,等.参芪扶正注射液预防蒽环类药物心脏毒性临床观察[J].实用临床医药杂志,2017,21(9):163-164.
[3]王兰荣,王海存,曹旸.参芪扶正注射液辅助治疗乳腺癌60例疗效观察[J].中华肿瘤防治杂志,2016,23(2):105-106.
[4]蔡辉,桂金川,方向东,等.应用参芪扶正液降低蒽环类化疗药物的心脏毒性作用[J].四川医学,2015,36(11):1565-1567.
[5]巩晓红,耿旭红,尹希,等.二维应变超声心动图评价乳腺癌患者表阿霉素化疗联合参芪注射液治疗后左心室收缩功能[J].临床荟萃,2014,29(12):1397-1399.
[6]王庆月.芪扶正注射液预防蒽环类药物相关心脏毒性反应30例临床观察[J].中国医药指南,2012,10(15):273-274.
[7]崔彦芝,张思洁,韩亚光,等.参芪扶正注射液预防蒽环类药物心脏毒性的临床观察[J].河北医药,2011,33(11):1685-1686.
[8]顾晓怡,姜藻,董丽钧.参芪扶正液抗蒽环类化疗药物所致心脏毒性的作用[J].东南大学学报(医学版),2008,49(5):375-377.
[9]宁亚利,姚淑莲,李东辉,等.参芪扶正注射液对表阿霉素心脏毒性保护作用的临床研究[J].陕西中医,2008,29(2):159-161.
[10]FENG Y Y,YANG Z J.Clinical application of the heart rate deceleration capacity test to predict epirubicin-induced cardiotoxicity[J].J Cardiovasc Pharmacol,2015,66(4):371-375.
[11]CARVALHO F S,BURGEIRO A,GARCIA R,et al.Doxorubicin-Induced cardiotoxicity:from bioenergetic failure and cell death to cardiomyopathy[J].Med Res Rev,2014,34(1):106-135.
[12]何蓉,李俊峰,薛成.慢性心力衰竭患者血清氨基末端脑钠肽前体及肌钙蛋白T的检测意义[J].检验医学与临床,2015,12(21):3204-3206.
[13]刘艳,王辉.肌钙蛋白I与肌酸激酶同工酶在老年人急性心肌梗死中的应用价值[J].检验医学与临床,2015,12(6):732-733,736.
[14]金之湲,胡燕华.超声心动图评估蒽环类化疗药物心脏毒性的临床研究进展[J].内蒙古医科大学学报,2016,38(3):255-258,263.
[15]赵爱群.动态心电图诊断无症状性心肌缺血的临床效果观察[J].检验医学与临床,2013,10(15):2021-2022.
[16]王建智,刘庆安,王建国.黄芪注射液拮抗阿霉素致小鼠心脏毒性的作用[J].第四军医大学学报,2006,27(4):366-366.
[17]王振富,钟灵,文德鉴.参芪扶正注射液对心肌缺血/再灌注损伤的保护作用[J].中国应用生理学杂志,2013,29(5):409-410.
[18]蔡英敏,胡海涛,马小亚,等.参芪扶正注射液对老龄大鼠脑缺血再灌注损伤的保护作用[J].中国中医药现代远程教育,2014,12(7):147-149.
[19]杨艳,胡喜田.参芪扶正注射液对联合放化疗患者心肌损伤的保护作用[J].现代中西医结合杂志,2018,27(9):963-966.
[20]刘其勇,卢凌珊,王际军,等.参芪扶正注射液治疗慢性心力衰竭研究进展[J].中国药物经济学,2014,12(4):287-288.
[21]王凯欢,吴嘉瑞,段笑娇,等.基于Meta分析的参芪扶正注射剂治疗慢性心力衰竭临床评价研究[J].药物流行病学杂志,2018,27(1):27-32.