β受体阻滞剂治疗射血分数保留性心力衰竭的网络meta分析

β-Blocker Therapy for Ejection Fraction Preserve of Heart Failure: A Network Meta-analysis

关键词:  β受体阻滞剂  网络meta分析  射血分数保留性心力衰竭  随机对照试验

Key words:  β-blocker  network meta-analysis  ejection fraction preserve of heart failure  randomized controlled trial

摘要:

目的 采用网络meta分析方法评价不同的β受体阻滞剂对射血分数保留性心衰的治疗效果。方法 计算机检索8个电子数据库中与射血分数保留性心力衰竭相关的随机对照试验，由2位评价员独立筛选文章、提取数据和评价纳入研究的风险偏倚后采用R 3.4.3软件Gemtc、Rjags包和STATA 14软件进行网络meta分析。结果 共纳入50个随机对照试验，包括4 089例患者。与未使用β受体阻滞剂相比，使用β受体阻滞剂能显著提高临床有效率、降低心率（P<0.05）；控制血压方面，美托洛尔、卡维地洛和阿罗洛尔效果优于未使用β受体阻滞剂（P<0.05）；在改善E/A比值方面，美托洛尔、卡维地洛和比索洛尔的效果优于未使用β受体阻滞剂（P<0.05）。累计排名曲线下面积值对干预措施排序显示卡维地洛疗效最好。结论 现有证据表明卡维地洛可能是应用前景较好的药物，但由于受纳入研究数量和质量的限制，本研究结论尚需开展更多高质量研究予以证实。

Abstract:

OBJECTIVE To evaluate the effect of different β-blockers for the efficacy of ejection fraction preserved heart failure by network meta-analysis. METHODS Eight databases were searched for randomized controlled trials(RCTs) of different β-blockers for patients with ejection fraction preserved heart failure. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Statistical analysis was performed by STATA 14 software and R 3.4.3 software, gemtc and rjags packages. RESULTS A total of 50 RCTs involving 4 089 patients were included. The results of network meta-analysis showed that compared with not use β-blockers, β-blockers could improve clinical efficacy, reduce heart rate(P<0.05). In the control of blood pressure, the effects of metoprolol, carvedilol, and arotinolol were better than those without β-blockers(P<0.05). The results of area under the cumulative ranking curve which ranked effectiveness of all β-blockers showed that carvedilol had the best effectiveness. CONCLUSION The current evidence shows that carvedilol may be effective in heart failure with reduced ejection fraction treatment. Due to limited quality and quantity of the included studies, more high-quality studies are needed to verify the above conclusion.