β受体阻滞剂治疗心力衰竭合并房颤患者的疗效及安全性的META分析

发布时间：2018-03-21 06:38

本文选题：心力衰竭　切入点：心房颤动　出处：《山东大学》2017年硕士论文　论文类型：学位论文

【摘要】：背景心力衰竭导致的循环衰竭常常引起临床死亡,是目前急需解决的问题。房颤引起快速心室率,导致卒中、栓塞和猝死的风险增高。心衰和房颤作为两种常见的心血管疾病,经常共同存在,互为因果,相互影响,导致更严重的临床状况以及更高的死亡风险,引起相关医疗卫生费用的增加。β受体阻滞剂的应用于心衰经历了一个漫长的认识过程,从一开始心力衰竭是应用的绝对禁忌症,到后来β受体阻滞剂在小部分人群中进行试验性治疗,发展到如今已经成为交感神经兴奋的慢性稳定性心衰患者治疗的基石,以改善心力衰竭患者的预后。同时β受体阻滞剂也被推荐用于房颤患者,以改善房颤引起的相关症状。最近有研究表明β受体阻滞剂在射血分数降低的心衰患者中,其临床获益在窦性心律和房颤的患者中存在差异,提示β受体阻滞剂的临床获益可能与节律有关。但目前并没有针对心衰合并房颤患者为目标人群的大规模临床研究证据,故使得临床应用β受体阻滞剂出现争议,为了明确β受体阻滞剂的治疗地位,我们拟对既往相关研究进行荟萃分析,希望能够为临床医师在心衰合并房颤患者应用β受体阻滞剂提供治疗依据。目的本研究旨在通过meta分析的方法进一步探讨β受体阻滞剂治疗以心衰合并房颤为目标人群的疗效及安全性,通过对相关预后指标包括患者的全因死亡率,心血管死亡率、再住院率、心血管死亡率和再住院率的联合终点以及治疗前后心率的变化进行系统分析,为今后β受体阻滞剂在目标研究人群的临床合理用药提供循证医学证据。研究方法利用 Medline、EMBase、Cochrane Library 等外文数据库和 CNKI、VIP、万方等中文数据库,同时检索相关综述提及的文献及纳入的文献提及的研究全面收集β受体阻滞剂治疗心力衰竭合并房颤患者的疗效及安全性评价的临床试验,文献收集截止至2016年12月。按照事先制定的标准决定文献是否纳入本研究。同时对符合要求的文献进行质量评价。阅读文献提取研究的基本信息和β受体阻滞剂治疗的有效性及安全性的相关信息,包括全因死亡率,心血管死亡率,再住院率和治疗前后心率的改变,利用RevMan 5.3软件和Stata 12等软件进行meta分析。通过对研究方法,β受体阻滞剂种类和射血分数的亚组分析,探讨异质性的来源和使研究更具有针对性。采用漏斗图法分析偏倚。结果本荟萃分析纳入8篇文献包含34187例患者,meta分析结果显示β阻滞剂对目标人群的全因死亡率发挥中性作用,OR=0.72,95%CI[0.50,1.05],p0.05,差异没有统计学意义。心血管死亡风险评估,OR=0.93,95%CI[0.66,1.30],p0.05,差异没有统计学意义。再住院率评估,OR=0.79,95%CI[0.53,1.17],p0.05,差异没有统计学意义。心血管死亡率和再住院率的联合终点,OR=0.69,95%CI[0.45,1.06],p0.05,差异没有统计学意义。治疗前后心率评估中,SMD=-9.11,95%CI[-9.38,-8.84],p0.05,β受体阻滞剂能够降低目标患者的心率。研究方法的亚组分析结果提示不同的研究方法对结果并没有造成统计学意义的影响。β受体阻滞剂种类的亚组分析提示可能卡维地洛治疗研究人群可以获得更好的临床结果。结论β受体阻滞剂治疗心力衰竭合并房颤患者的疗效及安全性评价中,该类药物治疗目标研究人群在观察终点包括全因死亡率,心血管死亡率,再住院率和联合终点均发挥中性作用,提示既不改善预后,也不增加死亡和住院风险。
[Abstract]:Background heart failure leads to circulatory failure often cause clinical death, is an urgent problem. Atrial fibrillation induced by rapid ventricular rate, stroke, embolism and sudden death. The increased risk of heart failure and atrial fibrillation as two common cardiovascular disease, often exist together, mutual causality, mutual influence, resulting in more severe clinical condition and a higher risk of death, caused by increased healthcare costs. The application of beta blockers has experienced a long process of cognition in heart failure, heart failure from the beginning is the contraindication of the application, then beta blockers treatment trials in the small part of the population, the development of today has become the cornerstone for the treatment of sympathetic nervous excitement in chronic stable patients with heart failure, in order to improve the prognosis of patients with heart failure. At the same time, beta blockers are recommended for patients with atrial fibrillation, in order to improve the real Related symptoms caused by atrial fibrillation. Recent studies have shown that beta blockers in patients with reduced ejection fraction, there are differences in the clinical benefit of sinus rhythm and atrial fibrillation in patients with clinical benefit suggest that beta blockers may be related to rhythm. But not for heart failure and atrial fibrillation in patients with the target population the large-scale clinical research evidence, the clinical application of beta blockers of disputes, in order to clarify the beta blocker treatment status, we intend to research on the previous meta-analysis, we hope to be able to atrial fibrillation patients clinicians use of beta blockers in heart failure treatment. Based on the purpose of this study is to further explore the method by meta analysis beta blockers in the treatment of congestive heart failure and atrial fibrillation for the efficacy and safety of the target population, based on the related prognostic indicators including all patients Causes of mortality, cardiovascular mortality, readmission rate, cardiovascular mortality and rehospitalization rate of the combined end point and heart rate changes before and after treatment were analyzed for beta blockers in the clinical use of target study population provide evidence of evidence-based medicine. The research method using Medline, EMBase, Cochrane, Library database and CNKI. VIP, Wanfang database Chinese, clinical trials and retrieval efficacy and safety evaluation of related researches mentioned in the literature and the literature into a comprehensive collection of beta blocker therapy for atrial fibrillation in patients with heart failure of the literature collection until December 2016. According to the standard decision prior to the development of the literature is included in this study. At the same time quality evaluation of the literature. To meet the requirements of the basic information and beta blockers on Extraction of reading literature and effectiveness of treatment Related to information security, including all-cause mortality, cardiovascular mortality, rehospitalization rate and heart rate changes before and after treatment, using RevMan 5.3 software and Stata 12 software for meta analysis. Based on the research methods, subgroup analysis of beta blocker type and ejection fraction, explore the sources of heterogeneity and make the research more targeted. Analysis of bias. The funnel plot results of this meta-analysis included 8 studies involving 34187 patients, the meta analysis results showed that beta blockers group on all-cause mortality play a neutral role, OR=0.72,95%CI[0.50,1.05], P0.05, the difference was not statistically significant. Cardiovascular death risk assessment, OR=0.93,95%CI[0.66,1.30], P0.05, the difference was not statistically significant.. the readmission rate evaluation, OR=0.79,95%CI[0.53,1.17], P0.05, the difference was not statistically significant. The combined end point of cardiovascular mortality and readmission rate, OR= 0.69,95%CI[0.45,1.06], P0.05, the difference was not statistically significant. The assessment of heart rate before and after treatment, SMD=-9.11,95%CI[-9.38, -8.84], P0.05, beta blockers can reduce the patient's heart rate target. Effects of subgroup analysis methods that different research methods on the results and did not cause statistically significant. Analysis showed that carvedilol in the study population can get better results the clinical subgroups of beta blocker species. Conclusion to evaluate the safety and efficacy of beta blocker therapy for atrial fibrillation in patients with heart failure in the treatment of the target population in the observation end point included all-cause mortality, cardiovascular mortality, readmission rate and the combined end point play a neutral role, suggesting that neither improve prognosis, also do not increase the risk of hospitalization and death.

【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.6;R541.75

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