关键词: 心力衰竭, 温阳利水, 利尿剂抵抗, 治疗结果, 病人安全, Meta分析

Abstract: Background　Diuretics are a cornerstone treatment for heart failure，but some patients will gradually develop reduced sensitivity to diuretics，resulting in weakened or even disappeared diuretic effect after a long-term use of them，which is clinically called diuretic resistance. Diuretic resistance is independently associated with heart failure-related mortality，which cannot be cured by western medicine，but has been proven to be partially improved by Wenyang Lishui Recipes（WLR），a type of Chinese medicine treatment. Objective　To systematically evaluate the efficacy and safety of WLR in treating heart failure with diuretic resistance. Methods　The authors searched the databases of PubMed，Web of Science，The Cochrane Library，EMBase，CNKI，Wanfang，VIP and CBM to screen randomized controlled trials（RCTs） comparing WLR with western medicine treatment against western medicine treatment in heart failure with diuretic resistance patients from inception to January 2020. The major primary outcome indicators included 24-hour urine collection，and left ventricular ejection fraction （LVEF）. Secondary outcome indicators included N-terminal proB-type natriuretic peptide （NT-proBNP），clinical symptom response rate，and cardiac function improvement rate. Safety indicators included serum potassium and creatinine. The “Risk of bias' tool described in Cochrane Handbook （version 5.1.0） and the modified Jadad Scale were used to evaluate the quality of the included RCTs. RevMan 5.3 and Stata 12.0 were used for meta-analysis. Results　Fourteen RCTs were included，involving 932 patients. Meta-analysis revealed that compared with western medicine treatment alone，WLR with western medicine treatment could further increase the 24-hour urine collection〔MD=499.41，95%CI（287.26，711.55），P<0.000 01〕，improve the LVEF〔MD=5.25，95%CI（3.28，7.22），P<0.000 01〕，clinical symptom response rate〔RR=1.26，95%CI（1.16，1.37），P<0.000 01〕，cardiac function improvement rate〔RR=1.25，95%CI（1.14，1.38），P<0.000 01〕，and serum potassium level〔MD=0.19，95%CI（0.14，0.24），P<0.000 01〕，as well as further decrease the NT-proBNP〔MD=-594.14，95%CI（-796.95，-391.33），P<0.000 01〕. Subgroup analysis found that WLR with western medicine treatment showed greater effects on improving LVEF no matter the sample size was greater or less than 80〔MD=2.04，95%CI（0.64，3.44），P=0.004；MD=6.61，95%CI（5.17，8.04），P<0.000 01〕. Conclusion　WLR with western medicine treatment may have better clinical efficacy in patients with heart failure with diuretic resistance with good safety.However，more high-quality clinical studies are still needed to verify this conclusion.

Key words: Heart failure, Wenyang lishui herbal medicine, Diuretic resistance, Treatment outcome, Patient safety, Meta-analysis