基于随机对照试验真武汤治疗老年慢性心力衰竭临床疗效的Meta分析^*

Meta-analysis of the clinical efficacy of Zhenwu decoction in treating chronic heart failure in the elderly based on randomized controlled trials

摘要

目的 基于Meta分析方法探讨真武汤治疗老年慢性心力衰竭的临床疗效与治疗安全性。方法 系统检索中国知网、中国生物医学文献服务系统、万方、中华医学期刊网、中国临床试验注册中心、国际传统医学临床试验注册平台、中文科技期刊数据库、the Cochrane Library、Embase、PubMed、Web of Science等中英文数据库,检索自建库至2025年11月收录关于真武汤治疗老年慢性心力衰竭的随机对照试验。采用Revman5.4软件和Stata18.0软件对数据进行Meta分析。结果 共纳入17项随机对照临床研究,总样本量1 782例患者,试验组与对照组各891例患者。Meta分析结果显示:两组患者在临床疗效、中医证候积分、左心室射血分数、左心室舒张末期内径、左心室收缩末期内径、氨基末端B型利钠肽前体、不良反应发生率方面比较,差异具有统计学意义(P<0.05)。结论 真武汤治疗老年慢性心力衰竭临床疗效确切,并且安全性良好,降低了不良反应发生率。

Abstract

Objective A meta-analysis-based investigation into the clinical efficacy and safety of Zhenwu Decoction in treating chronic heart failure in the elderly. Methods The system searches Chinese and English databases such as CNKI, China Biomedical Literature Service System, Wanfang, Chinese Medical Journals Network, China Clinical Trial Registry, International Traditional Medicine Clinical Trial Registration Platform,CSTJ, the Cochrane Library, Embase,PubMed, and Web of Science, with data collection up to November 2025, to include randomized controlled trials on the treatment of chronic heart failure in the elderly with Zhenwu Decoction. Meta-analysis of the data was conducted using RevMan 5.4 and Stata 18.0 software. Results 17 randomized controlled clinical studies were included with a total sample size of 1 782 patients, with 891 patients in the experimental group and 891 patients in the control group.The meta-analysis results showed statistically significant differences between the two groups of patients in terms of clinical efficacy, TCM syndrome scores, left ventricular ejection fraction, left ventricular end-diastolic diameter, left ventricular end-systolic diameter, N-terminal pro-B-type natriuretic peptide, and incidence of adverse reactions (P<0.05). Conclusion Zhenwu Decoction has definite clinical efficacy and good safety in treating elderly chronic heart failure, reducing the incidence of adverse reactions.

关键词

随机对照试验 / 真武汤 / 老年慢性心力衰竭 / Meta分析

Key words

Randomized controlled trials / Zhenwu decoction / Elderly chronic heart failure / Meta-analysis

[1] Konstantinides S V, Meyer G, Becattini C, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS) [J].Eur Heart J,2020,41(4):543-603.
[2] 中华医学会心血管病学分会, 中国医师协会心血管内科医师分会, 中国医师协会心力衰竭专业委员会, 等. 中国心力衰竭诊断和治疗指南2024[J]. 中华心血管病杂志, 2024, 52(3): 235-275.
The Chinese Society of Cardiology,the Chinese Medical Doctor Association Committee of Cardiology, the Chinese Medical Doctor Association Committee of Heart Failure, et al. Chinese Guidelines for the Diagnosis and Treatment of Heart Failure 2024[J]. Chin J Cardiol, 2024, 52(3): 235-275.
[3] 徐亚妹, 周京敏. 衰弱与老年心力衰竭[J]. 老年医学与保健, 2024, 30(2): 272-274.
Xu Y M, Zhou J M. Frailty and senile heart failure[J]. Geriatr Health Care, 2024, 30(2): 272-274.
[4] 梁堃, 高燕, 刘科卫, 等. 伊伐布雷定联合托拉塞米治疗老年慢性心力衰竭的疗效及对相关指标的影响[J]. 国际老年医学杂志, 2025, 46(5): 588-592.
Liang K, Gao Y, Liu K W, et al. Efficacy of ivabradine combined with torasemide in elderly patients with chronic heart failure and its effect on heart failure-related indices[J]. Int J Geriatr, 2025, 46(5): 588-592.
[5] 陈易珠, 李彩霞, 刘梦君, 等. 中医药益气温阳、活血利水法治疗慢性心力衰竭作用机制的研究进展[J]. 上海中医药杂志, 2024, 58(7): 89-94.
Chen Y Z, Li C X, Liu M J, et al. Research progress on mechanism of nourishing qi and warming Yang, activating blood and diverting water of traditional Chinese medicine in treatment of chronic heart failure[J]. Shanghai J Tradit Chin Med, 2024, 58(7): 89-94.
[6] 田庄, 张抒扬. 《中国心力衰竭诊断和治疗指南2024》要点解读[J]. 协和医学杂志, 2024, 15(4): 801-806.
Tian Z, Zhang S Y. Interpretation on Chinese guidelines for the diagnosis and treatment of heart failure 2024[J]. Med J Peking Union Med Coll Hosp, 2024, 15(4): 801-806.
[7] 朱明军, 毛静远, 张健. 慢性心力衰竭临床研究结局指标选择与应用专家共识[J]. 中医杂志, 2024, 65(11): 1196-1200.
Zhu M J, Mao J Y, Zhang J. Expert consensus on the selection and application of outcome indicators in clinical studies of chronic heart failure [J]. J Tradit Chin Med, 2024, 65 (11): 1196-1200.
[8] 汪洋. Cochrane偏倚风险评估工具简介[J]. 中国全科医学, 2019, 22(11): 1322.
Wang Y. Brief introduction of Cochrane bias risk assessment tool[J]. Chin Gen Pract, 2019, 22(11): 1322.
[9] 张楗炆. 真武汤结合西药治疗老年慢性心力衰竭35例[J]. 山西中医, 2004, 20(6): 26-27.
Zhang J W. Zhenwu decoction combined with western medicine in the treatment of 35 cases of senile chronic heart failure[J]. Shanxi J Tradit Chin Med, 2004, 20(6): 26-27.
[10] 肖向金, 丁文涛, 林赣州. 中西医结合治疗老年慢性心力衰竭的临床观察[J]. 中国老年保健医学, 2007, 5(6): 11-12.
Xiao X J, Ding W T, Lin G Z. Clinical observation on the treatment of senile chronic heart failure with combination of traditional Chinese and western medicine[J]. Chin J Geriatr Care, 2007, 5(6): 11-12.
[11] 代景贤, 方春凤. 中西医结合治疗老年性慢性肺心病心力衰竭50例疗效观察[J]. 临床和实验医学杂志, 2008, 7(3): 84-85.
Dai J X, Fang C F. Clinical observation on 50 cases of senile chronic cor pulmonale with heart failure treated by combination of traditional Chinese and western medicine[J]. J Clin Exp Med, 2008, 7(3): 84-85.
[12] 黄君敖, 赵晓琴. 加减真武汤治疗慢性心功能不全临床研究[J]. 中医临床研究, 2015, 7(23): 64-65.
Huang J A, Zhao X Q. Clinical observation on treating chronic cardiac insufficiency with the Zhenwu decoction[J]. Clin J Chin Med, 2015, 7(23): 64-65.
[13] 李静. 真武汤加减联合西药治疗老年慢性心衰的疗效观察[J]. 中西医结合心血管病电子杂志, 2018, 6(24): 159-160.
Li J. Clinical observation of Zhenwu decoction combined with western medicine in the treatment of senile chronic heart failure[J]. Cardiovasc Dis J Integr Tradit Chin West Med, 2018, 6(24): 159-160.
[14] 王金梁. 真武汤治疗心力衰竭临床观察[J]. 光明中医, 2019, 34(14): 2110-2112.
Wang J L. Clinical observation on Zhenwu decoction in the treatment of heart failure[J]. Guangming J Chin Med, 2019, 34(14): 2110-2112.
[15] 胡淑云, 曹娟. 真武汤联合洋地黄类药物治疗阳虚水泛证型心力衰竭的临床疗效[J]. 中国药物经济学, 2019, 14(9): 117-119.
Hu S Y, Cao J. Clinical efficacy of Zhenwu decoction combined with digitalis in the treatment of congestive heart failure with syndrome of water overflowing due to Yang deficiency[J]. China J Pharm Econ, 2019, 14(9): 117-119.
[16] 周蔓菁, 唐其柱. 真武汤对老年慢性心力衰竭患者血流动力学 、MMP-9和心功能的影响[J]. 世界中医药, 2019, 14(4): 926-930.
Zhou (M /W)J, Tang Q Z. Effects of Zhenwu decoction on hemodynamics, MMP-9 and cardiac function in elderly patients with chronic heart failure[J]. World Chin Med, 2019, 14(4): 926-930.
[17] 张海洋, 冯静茹, 李凡, 等. 真武汤加减联合ACEI对老年女性慢性心力衰竭患者血清E2、NT-proBNP及心功能的影响[J]. 现代中西医结合杂志, 2020, 29(29): 3252-3255.
Zhang H Y, Feng J R, Li F, et al. Effect of Zhenwu decoction combined with ACEI on serum E2, NT-proBNP and cardiac function in elderly women with chronic heart failure[J]. Mod J Integr Tradit Chin West Med, 2020, 29(29): 3252-3255.
[18] 张成双. 真武汤加减对慢性心力衰竭(阳虚水泛)患者治疗前后中医证候积分、心功能分级的变化分析[J]. 临床研究, 2020, 28(7): 125-126.
Zhang C S. Analysis on the changes of TCM syndrome integral and cardiac function classification of patients with chronic heart failure (Yang deficiency and watery) before and after treatment with Zhenwu decoction[J]. Clin Res, 2020, 28(7): 125-126.
[19] 姜淑华. 中医真武汤加减疗法医治心肾阳虚型慢性心衰患者的临床应用效果观察[J]. 医学食疗与健康, 2020, 18(9): 29, 31.
Jiang S H. Clinical observation on the effect of Zhenwu decoction in the treatment of chronic heart failure with heart-kidney Yang deficiency[J]. Med Diet Health, 2020, 18(9): 29, 31.
[20] 辛佐雅. 真武强心汤联合西药治疗老年心力衰竭的临床疗效观察[J]. 中国医药指南, 2020, 18(20): 182-183.
Xin Z Y. Clinical observation of Zhenwuqiangxin decoction combined with western medicine in the treatment of senile heart failure[J]. Guide China Med, 2020, 18(20): 182-183.
[21] 武前福, 刘毅, 宋卫东, 等. 复方真武汤联合常规西药治疗老年慢性心力衰竭的效果[J]. 中国临床保健杂志, 2021, 24(5): 635-639.
Wu Q F, Liu Y, Song W D, et al. Effect of Zhenwu Decoction combined with conventional western medicine on cardiac function in patients with senile cardiac failure with Median ejection fraction[J]. Chin J Clin Healthc, 2021, 24(5): 635-639.
[22] 张雪然. 真武强心汤联合常规西药治疗老年心力衰竭患者的效果[J]. 中国民康医学, 2022, 34(19): 88-90.
Zhang X R. Effects of Zhenwu Qiangxin decoction combined with conventional western medicine in treatment of elderly patients with heart failure[J]. Med J Chin People's Health, 2022, 34(19): 88-90.
[23] 江建军. 真武汤加减治疗阳虚水泛型慢性心力衰竭的效果分析[J]. 中华养生保健, 2023, 41(7): 34-37.
Jiang J J. Effect analysis of Zhenwu decoction on chronic heart failure of Yang-deficiency and water-flood type[J]. Chin Health Care, 2023, 41(7): 34-37.
[24] 严羽, 王辰辰. 真武汤加减联合常规西医治疗老年慢性心力衰竭患者的临床研究[J]. 现代医学与健康研究电子杂志, 2025, 9(22): 97-99.
Yan Y, Wang C C. Clinical study on the treatment of elderly patients with chronic heart failure by Zhenwu decoction combined with routine western medicine[J]. Mod Med Health Res Electron J, 2025, 9(22): 97-99.
[25] 李峥亮, 刘丽军, 张永强. 真武汤对老年慢性心力衰竭合并利尿剂抵抗患者临床症状、托拉塞米用量及不良反应的影响[J]. 中国老年学杂志, 2025, 45(22): 5377-5380.
Li Z L, Liu L J, Zhang Y Q. Effect of Zhenwu decoction on clinical symptoms, dosage of torasemide and adverse reactions in elderly patients with chronic heart failure complicated with diuretic resistance[J]. Chin J Gerontol, 2025, 45(22): 5377-5380.
[26] 张盛, 李佳, 刘金成, 等. 慢性心力衰竭患者肾素、血管紧张素Ⅱ及BNP变化及其与心功能的关系[J]. 分子诊断与治疗杂志, 2024, 16(2): 300-303.
Zhang S, Li J, Liu J C, et al. Changes of renin, angiotensinⅡ and BNP and its relationship with cardiac function in patients with chronic heart failure[J]. J Mol Diagn Ther, 2024, 16(2): 300-303.
[27] 陈可冀, 吴宗贵, 朱明军, 等. 慢性心力衰竭中西医结合诊疗专家共识[J]. 心脑血管病防治, 2016, 16(5): 340-347.
Wu C, Wu Z G, Zhu M J, et al. Expert consensus on diagnosis and treatment of chronic heart failure with integrated traditional Chinese and western medicine[J]. Cardio Cerebrovasc Dis Prev Treat, 2016, 16(5): 340-347.
[28] 张凯清, 韩景波, 饶亚平, 等. 中医药治疗慢性心力衰竭的研究进展[J]. 中医临床研究, 2024, 16(30): 78-81.
Zhang K Q, Han J B, Rao Y P, et al. A review on the treatment of chronic heart failure in traditional Chinese medicine[J]. Clin J Chin Med, 2024, 16(30): 78-81.
[29] 王兴, 陈子琪, 王晓琳, 等. 真武汤治疗心力衰竭的作用机制[J]. 中国老年学杂志, 2023, 43(22): 5608-5611.
Wang X, Chen Z Q, Wang X L, et al. Mechanism of Zhenwu decoction in treating heart failure[J]. Chin J Gerontol, 2023, 43(22): 5608-5611.
[30] 闫海峰, 张泽宇, 姚明鹤, 等. 桂枝-白芍治疗慢性心力衰竭作用机制的网络药理学分析[J]. 中国中医基础医学杂志, 2023, 29(3): 464-469.
Yan H F, Zhang Z Y, Yao M H, et al. Network pharmacological analysis of mechanism of cinnamomum cassia-radix paeoniae alba in treating chronic heart failure[J]. J Basic Chin Med, 2023, 29(3): 464-469.
[31] 郭慧. 真武汤联合强心利尿贴治疗慢性心衰阳虚水泛证临床观察[J]. 光明中医, 2024, 39(4): 708-710.
Guo H. Clinical observation on Zhenwu decoction combined with Qiangxin diuretic plaster in treating chronic heart failure with Yang deficiency and water flooding syndrome[J]. Guangming J Chin Med, 2024, 39(4): 708-710.
[32] 赖涌. 真武汤治疗慢性心力衰竭患者的临床研究及安全性评估[J]. 光明中医, 2023, 38(18): 3552-3554.
Lai Y. Clinical study and safety evaluation of Zhenwu decoction in treating chronic heart failure[J]. Guangming J Chin Med, 2023, 38(18): 3552-3554.

基金资助

^*国家中医药管理局第五批全国中医临床优秀人才研修项目(国中医药人教函〔2022〕1号);中国中医科学院西苑医院能力提升项目(XYZX0101-14)