作者：钮岳岳，侯承志，程晓振，艾克热木·艾尔肯，李红萍，冯玲

单位：

1.100029北京市，北京中医药大学研究生院　2.100053北京市，中国中医科学院广安门医院干部保健科

Units：

1.Graduate School of Beijing University of Chinese Medicine, Beijing 100029, China2.Cadres Health Protection Department, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053,China

关键词：

　心力衰竭；射血分数改善的心力衰竭；射血分数恢复的心力衰竭；全因死亡率；再住院率；复合终点；Meta分析

Keywords：

Heart failure; Heart failure with improved ejection fraction; Heart failure with recovered ejection fraction;All-cause mortality; Rehospitalization rate; Composite endpoint; Meta-analysis

CLC：

R 541.62

DOI：

10.12114/j.issn.1008-5971.2023.00.241

Funds：

中国中医科学院科技创新工程课题（CI2021A03001，CI2021A03008）；保健专项课题（2022YB73）

摘要：

目的　系统评价射血分数改善的心力衰竭（HFimpEF）/射血分数恢复的心力衰竭（HFrecEF）患者全因死亡率、再住院率及复合终点发生率。方法　计算机检索Cochrane Library、PubMed、Embase、Web of Science、中国生物医学文献数据库、中国知网、万方数据知识服务平台、维普网等数据库中HFimpEF/HFrecEF患者预后相关文献，检索时限为建库至2023年1月。主要结局指标包括全因死亡率，次要结局指标包括再住院率及复合终点发生率。提取纳入文献的资料，采用纽卡斯尔-渥太华量表（NOS）评价文献质量，采用Stata 14.0与RevMan 5.4软件进行Meta分析。结果　本研究纳入11篇文献，共包含射血分数降低的心力衰竭（HFrEF）患者5 873例，射血分数保留的心力衰竭（HFpEF）患者1 819例，HFimpEF患者465例，HFrecEF患者1 583例。Meta分析结果显示，HFimpEF/HFrecEF患者全因死亡率低于HFrEF患者〔风险比（HR）=2.35，95%CI（1.85，2.99），P＜0.000 01〕和HFpEF患者〔HR=1.99，95%CI（1.56，2.54），P＜0.000 01〕。HFimpEF/HFrecEF患者再住院率低于HFrEF患者〔HR=1.61，95%CI（1.41，1.85），P＜0.000 01〕和HFpEF患者〔HR=1.47，95%CI（1.23，1.76），P＜0.000 1〕。HFimpEF/HFrecEF患者复合终点发生率低于HFrEF患者〔HR=1.75，95%CI（1.28，2.40），P=0.000 5〕和HFpEF患者〔HR=1.63，95%CI（1.24，2.16），P=0.000 5〕。根据发表年份、国家、研究类型、随访时间、校正因素数量进行亚组分析，结果显示，在不同亚组中HFimpEF/HFrecEF患者全因死亡率均低于HFrEF患者（P＜0.05）。结论　现有证据显示，HFimpEF/HFrecEF患者全因死亡率、再住院率、复合终点发生率低于HFrEF、HFpEF患者。

Abstract：

Objective To systematically evaluate the all-cause mortality, rehospitalization rate and compositeendpoint incidence rate in patients with heart failure with improved ejection fraction (HFimpEF) or heart failure with recoveredejection fraction (HFrecEF) . Methods Databases including Cochrane Library, PubMed, Embase, Web of Science, CBM,CNKI, Wanfang Data and VIP were retrieved to search for studies on the prognosis of HFimpEF/HFrecEF patients from databaseestablishment to January 2023. The primary outcome indicator was all-cause mortality, the secondary outcome indicators werereadmission rate and composite endpoint incidence rate. The data of the included literature were extracted, the Newcastle-OttawaScale (NOS) was used to evaluate the quality of the studies. Stata 14.0 and RevMan 5.4 were used for meta-analysis. ResultsA total of 11 articles were included, and involving 5 873 heart failure with reduced ejection fraction (HFrEF) patients, 1 819 heartfailure with preserved ejection fraction (HFpEF) patients, 465 HFimpEF patients, 1 583 HFrecEF patients. Meta-analysis resultsshowed that the all-cause mortality of HFimpEF/HFrecEF patients was lower than that of HFrEF patients [hazard ratio (HR) =2.35,95%CI (1.85, 2.99) , P < 0.000 01] and HFpEF patients [HR=1.99, 95%CI (1.56, 2.54) , P < 0.000 01] . The rehospitalization rateof HFimpEF/HFrecEF patients was lower than that of HFrEF patients [HR=1.61, 95%CI (1.41, 1.85) , P < 0.000 01] and HFpEF patients [HR=1.47, 95%CI (1.23, 1.76) , P < 0.000 1] . The composite endpoint incidence rate of HFimpEF/HFrecEF patients waslower than that of HFrEF patients [HR=1.75, 95%CI (1.28, 2.40) , P=0.000 5] and HFpEF patients [HR=1.63, 95%CI (1.24, 2.16) ,P=0.000 5] . Subgroup analysis was conducted according to the publication year, country, study type, follow-up time, and numberof correction factors, and the results showed that the all-cause mortality of HFimpEF/HFrecEF patients in different subgroupswas lower than that of HFrEF patients (P < 0.05) . Conclusion The available evidence shows that the all-cause mortality,rehospitalization rate and composite endpoint incidence rate of HFimpEF/HFrecEF patients are lower than those of HFrEF andHFpEF patients.

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