Efficacy and safety of iron therapy in patients with chronic heart failure and iron deficiency: a systematic review and meta-analysis based on 15 randomised controlled trials
Efficacy and safety of iron therapy in patients with chronic heart failure and iron deficiency: a systematic review and meta-analysis based on 15 randomised controlled trials
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铁剂治疗对慢性心力衰竭缺铁患者的疗效和安全性：基于 15 项随机对照试验的系统评价和荟萃分析
DOI：
10.1136/postgradmedj-2019-137342
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发表时间：
2020
影响因子：
5.1
通讯作者：
Zhou Yafeng
中科院分区：
文献类型：
--
作者：
Zhang Junyi Hu Shengda Jiang Yufeng;Zhou Yafeng
近年来，研究慢性心力衰竭(CHF)和缺铁(ID)患者铁管理的试验如雨后春笋般涌现，但结果仍然不一致。这项荟萃分析的目的是全面评估铁剂疗法在CHF和ID患者中的有效性和安全性。在截至2019年7月31日的PubMed、Embase、Cochrane图书馆、Ovid和Web of Science上进行文献搜索，搜索比较铁剂疗法与安慰剂在CHF和ID患者中的随机对照试验(RCT)，而不考虑是否存在贫血。已发表的研究报告了以下任何结果的数据：全因死亡、心血管住院、不良事件、纽约心脏协会(NYHA)功能分级、左心室射血分数、N末端b型利钠肽、峰值耗氧量、6 分钟步行试验(6MWT)距离和生活质量(QOL)参数。纳入随机对照试验15例，共1627例患者(铁疗组911例，对照组716例)。铁剂疗法可以降低心血管疾病住院的风险(OR0.35，95% 可信区间0.12至0.99，p=0.049)，但对减少全因死亡(OR0.59，95% 可信区间0.33至1.06，p=0.078)或心血管死亡(OR0.80，95% 可信区间0.39至1.63，p=0.540)无效。铁剂治疗后，左心室射血分数(−)(MD+4.35，95% CI 0.69~8.00，p=0.020)、6MWT距离(MD+35.44，95% CI 11.55~59.33，p=0.004)降低，QOL：EQ-5D评分改善(MD+4.07，95% CI 0.84~7.31，p=0.014)；明尼苏达州心力衰竭生活问卷评分(MD−19.47，95% CI−23.36至−15.59，p<；0.001)和患者总体评估量表(MD 0.71，95% CI 0.32至1.10，p<；0.001)。铁剂治疗组与对照组的不良事件或严重不良事件发生率差异无统计学意义。铁疗法减少了患有ID的CHF患者的心血管住院时间，并额外改善了患有ID和贫血的CHF患者的心功能、运动能力和生活质量，而不会增加不良事件。
Trials studying iron administration in patients with chronic heart failure (CHF) and iron deficiency (ID) have sprung up these years but the results remain inconsistent. The aim of this meta-analysis was to comprehensively evaluate the efficacy and safety of iron therapy in patients with CHF and ID. A literature search was conducted across PubMed, Embase, Cochrane Library, OVID and Web of Science up to 31 July 2019 to search for randomised controlled trials (RCT) comparing iron therapy with placebo in CHF with ID, regardless of presence of anaemia. Published studies reporting data of any of the following outcomes were included: all-cause death, cardiovascular hospitalisation, adverse events, New York Heart Association (NYHA) functional class, left ventricular ejection fraction (LVEF), N-terminal pro b-type natriuretic peptide, peak oxygen consumption, 6 min walking test (6MWT) distance and quality of life (QoL) parameters. 15 RCTs with a total of 1627 patients (911 in iron therapy and 716 in control) were included. Iron therapy was demonstrated to reduce the risk of cardiovascular hospitalisation (OR 0.35, 95% CI 0.12 to 0.99, p=0.049), but was ineffective in reducing all-cause death (OR 0.59, 95% CI 0.33 to 1.06, p=0.078) or cardiovascular death (OR 0.80, 95% CI 0.39 to 1.63, p=0.540). Iron therapy resulted in a reduction in NYHA class (mean difference (MD) −0.73, 95% CI −0.99 to −0.47, p<0.001), an increase in LVEF (MD +4.35, 95% CI 0.69 to 8.00, p=0.020), 6MWT distance (MD +35.44, 95% CI 11.55 to 59.33, p=0.004) and an improvement in QoL: EQ-5D score (MD +4.07, 95% CI 0.84 to 7.31, p=0.014); Minnesota Living With Heart Failure Questionnaire score (MD −19.47, 95% CI −23.36 to −15.59, p<0.001) and Patients Global Assessment (PGA) scale (MD 0.71, 95% CI 0.32 to 1.10, p<0.001). There was no significant difference in adverse events or serious adverse events between iron treatment group and control group. Iron therapy reduces cardiovascular hospitalisation in patients with CHF with ID, and additionally improves cardiac function, exercise capacity and QoL in patients with CHF with ID and anaemia, without an increase of adverse events.