卡维地洛治疗儿童慢性心力衰竭的Meta分析

发布时间：2018-01-01 07:46

本文关键词：卡维地洛治疗儿童慢性心力衰竭的Meta分析　出处：《重庆医科大学》2016年硕士论文　论文类型：学位论文

【摘要】：背景:慢性心力衰竭(CHF)是各种严重心脏器质性或功能性病变逐步发展到终末期的一种临床综合征,在婴幼儿及青少年时期并不少见。传统的抗CHF的药物包括增强心肌收缩力类(洋地黄类)、扩张血管类(ACEI)、利尿剂等。后经过大规模的临床试验证实β受体阻滞剂在改善心衰患者心功能及预后方面具有显著疗效,可提高慢性心力衰竭患者生存率[1]。卡维地洛作为第三代β受体阻滞剂,可非选择性阻断肾上腺能受体从而改善心肌缺血,部分逆转心室重构。卡维地洛(carvedilol)治疗成人CHF已得到广泛认可,但对于儿童的疗效尚缺乏循证证据。目的:通过纳入多个临床随机对照试验进行Meta分析,系统评价卡维地洛在治疗儿童慢性心力衰竭中的疗效,从而为临床用药提供辩证依据。方法:以“卡维地洛、心力衰竭、儿童”及其自由词为关键词检索Pubmed、Cochrane图书馆、EMbase等外文数据库及万方数据库、中国生物医学文献数据库、中国知网、维普等中文数据库从建库到2016年1月收录的临床随机对照人体试验(Randomized Controlled Trails,RCT)。严格参照制定的纳入排除标筛选出符合要求的研究后参照Cochrane系统评价手册5.1偏倚风险评估标准进行各种偏倚风险及质量评价,研究的合并分析采用Cochrane协作网提供的Rev Man 5.3软件进行。终点观察指标若为计量资料则分析统计量以平均数(Mean Difference,MD)表示,若为计数资料则分析统计量采用比值比(Odds ratio,OR)表示,各统计量均计算出95%可信区间(Confidence Interval,CI)。结果:共5项临床随机对照试验包括348例儿童慢性心力衰竭衰患者被纳入研究。Meta分析结果显示:(1)在传统纠正心力衰竭治疗的基础上给予卡维地洛治疗,对儿童慢性心力衰竭患者左室射血分数(Left Ventricular Ejection Fraction,LVEF)(MD=5.67,95%CI:2.38~8.96,P=0.0007)、左室短轴缩短率(Left Ventricular Fraction Shorting,LVFS)(MD=3.47,95%CI:0.88~6.06,P=0.009)等指标改善良好,差异具有统计学意义,而对左室舒张末期内径(left ventricular end-diastolic inner diameter,LVDD)(MD=-1.80,95%CI:-5.60~2.01,P=0.36)、左室收缩末期内径(left ventricular end-systolic inner diameter,LVSD)(MD=-1.99,95%CI:-6.69~2.72,P=0.41)、临床症状改善(OR=1.20,95%CI:0.72~2.01,P=0.48)等指标的差异无统计学意义。结论:卡维地洛在治疗儿童慢性心力衰竭中,能显著提高LVEF、LVFS,但对于LVDD、LVSD、临床症状改善等方面无显著疗效。
[Abstract]:Background: chronic heart failure (CHF) is a kind of clinical syndrome which develops gradually to the end stage of various serious organic or functional diseases of the heart. It is not uncommon in infancy and adolescence. Traditional drugs against CHF include increased myocardial contractility (digitalis, vasodilators, ACEI). After the large scale clinical trial, it was proved that 尾 -blocker had significant effect on improving heart function and prognosis in patients with heart failure, and could improve the survival rate of patients with chronic heart failure. [1. Carvedilol, as a third generation 尾 receptor blocker, can block adrenal receptor and improve myocardial ischemia. Partial reversal of ventricular remodeling. Carvedilol (carvedilol) treatment of adult CHF has been widely accepted. Objective: to evaluate the efficacy of carvedilol in children with chronic heart failure (CHF) by Meta analysis in a number of randomized controlled trials. Methods: "Carvedilol, Heart failure, Children" and its free words were used to search the Pubmedan Cochrane Library. EMbase and other foreign language databases and Wanfang database, China Biomedical Literature Database, China knowledge Network. From the construction of the database to the clinical randomized controlled Controlled Trails in January 2016. According to the established inclusion exclusion standard, the research that meets the requirements was selected and then the bias risk and quality were evaluated according to the 5.1 bias risk assessment criteria of the Cochrane system evaluation manual. The combined analysis of the study was carried out using the Rev Man 5.3 software provided by the Cochrane Cooperative Network. If the endpoint observation index is a metrological data, the analysis statistics are averaged (. Mean Difference. MDD indicated that if the data were counted, the analysis statistics were expressed by the ratio ratio of Odds ratiooris. The confidence Interval of 95% confidence interval was calculated by each statistic. Results: a total of 5 randomized controlled trials including 348 children with chronic heart failure were included in the study. Meta-analysis showed that: 1). Carvedilol was given on the basis of traditional treatment for heart failure. Left ventricular ejection fraction (left Ventricular Ejection fractionation) in children with chronic heart failure (CHF) was 5.67. The left ventricular short axis shortening rate was left Ventricular Fraction Shorting. LVFS MDN 3.47 / 95 CI: 0.886.06 / P0. 009) and so on, the difference is statistically significant. Left ventricular end-diastolic inner diameter. LVDDD / MD-1.80 / 95 / CI: -5.602.01 / 0.36). Left ventricular end-systolic inner diameterus left ventricular end systolic diameterus MD-1.99. 95 CI: -6.69% 2.72% Pao 0.41, clinical symptom improvement 1.20% 1.20% 0.72% 2.01. Conclusion: carvedilol can significantly increase LVEFV LVFSs in children with chronic heart failure, but for LVDDD LVSD. There was no significant effect on the improvement of clinical symptoms.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R725.4

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