别嘌呤醇治疗慢性心力衰竭随机对照研究的系统评价

Efficacy of allopurinol for chronic heart failure：a systematic review of randomized controlled trials

摘要:

目的：系统评价别嘌呤醇对慢性心力衰竭患者左室收缩功能的改善作用。方法：计算机检索PubMed、The Cochrane li－brary、ISI、中国生物医学文献数据库（CBM）、中国学术期刊全文数据库（CNKI）、维普中文科技期刊全文数据库（VIP）和万方数据库（WanFang Data），检索别嘌呤醇治疗慢性心力衰竭的随机对照试验（RCT），检索时限均为各数据库建库至2014年8月。采用RevMan 5.3 软件进行Meta分析，计量资料采用均数差（mean difference，MD）或标准化均数差（standard mean difference，SMD）及其95％CI作为疗效分析统计量，计数资料采用相对危险度（relative risk，RR）及其95％可信区间（confidence interval，CI）作为疗效分析统计量。结果：共计21个随机对照研究（randomized controlled trials，RCTs），1384例患者纳入分析。Meta分析结果显示：别嘌呤醇组较对照组能提高左室射血分数（left ventricular ejection fraction，LVEF）（MD=5.83，95%CI=4.65～7.01，P=0.000），亚组分析显示别嘌呤醇对基线合并高尿酸和非高尿酸血症患者均能改善LVEF，分别为（MD=6.09，95%CI=4.73～7.45，P=0.000），（MD=4.49，95%CI=2.99～5.99，P=0.000）。同时别嘌呤醇组还能明显降低血浆B型利钠肽（B-type natriuretic peptide，BNP）/N末端B型利钠肽原（N terminal pro-BNP，NT-proBNP）水平（SMD=-0.62，95%CI=-1.00～-0.24，P=0.001）。3篇文献报道了不良反应事件，两组间无差别无统计学意义。结论：别嘌呤醇能显著改善慢性心力衰竭患者的心功能。但受纳入研究质量限制，本系统评价结果尚需更多高质量、大样本、多中心随机对照试验验证。

Abstract:

Objective：To systemically review the effects of allopurinol on heart systolic function in patients with chronic heart failure. Methods：Randomized controlled trials（RCTs） in electronic databases（PubMed，The Cochrane library，ISI，CBM，CNKI，VIP and WanFang Data） and article reference lists（until August 2014） were searched，The therapeutic effects of allopurinol on patients with chronic heart failure were reviewed using Ｍeta-analytical techniques. Mean difference（MD） or standard MD（SMD） and relevant 95% confidence interval（CI） for continuous variables，relative risk（RR） and relevant 95%CI for dichotomous data were calculated. The RevMan 5.3 software package was used for the Ｍeta-analysis. Results：A total of 21 RCTs with 1 384 chronic heart failure patients were included in the Ｍeta-analysis. The present Ｍeta-analysis showed that there was a significantly higher left ventricular ejection fraction（LVEF） in allopurinol arm than that in control arm（MD=5.83，95%CI=4.65 to 7.01，P=0.000）. Subgroup analysis consistently suggested that allopurinol can significantly improve the LVEF regardless of whether included patients suffered from hyperuricemia（MD=6.09，95%CI=4.73 to 7.45，P=0.000），or not（MD=4.49，95%CI=2.99 to 5.99，P=0.000） at baseline，respectively. Similarly，allop－urinol can also significantly decrease the plasma B-type natriuretic peptide（BNP）/N terminal pro-BNP（NT-proBNP） level than control group（SMD=-0.62，95%CI=-1.00 to -0.24，P=0.001）. Three RCTs reported the side effects of allopurinol，and there was no significant difference in incidence of the side effects between the two arms. Conclusion：The present Meta-analysis suggested that conventional treatment combined with allopurinol therapy for chronic heart failure is effective and safe. Due to the limitation of the quality of included studies，this conclusion should be further confirmed with more high quality and large sample studies.