A Meta-analysis On Treatment Of Chronic Heart Failure With Xanthine Oxidase Inhibition

Objective: To assess the effects and safety of Xanthine Oxidase Inhibition( XOI) for the treatment of chronic heart failure(CHF).Methods: The databases of Pubmed, Embase, The Cochrane Library,WanFang Daterbase, China National Network Knowledge Infrastrucure(CNKI) and VIP Database were searched with computer for collecting randomized controlled trails(RCTs)about the treatment of CHF with XOI from inception to December, 2015. Two reviewers independently screened studies,extracted data, and assessed the methodological quality. Then, mata-analysis was performed using RevMan 5.3 software.Results:The article included 24 RCTs with a total of 2118 patients. In the meta-analysis, the clinical effect on CHF was significantly better in XOI group(RR=1.35,95%CI=1.02 to 1.78, P=0.04).In XOI group, left ventricular ejection fraction(LVEF) increased(MD=5.39,95%CI=4.15 to6.63, P < 0.00001), left ventricular end-diastolic diameter(LVEDD)decreased(MD=-4.65, 95%CI=-5.31 to-3.99, P < 0.00001), leftventricular end-systolic diameter(LVESD) decreased(MD=-3.47,95%CI=-5.36 to-1.57, P=0.0003),and the level of the plasma BNP/NT-proBNPalso decreased(SMD=-0.48, 95%CI=-0.84 to-0.13,P=0.007). But there is no significant difference between the two gruops in6-minute walk test, the incidence of cardiovascular death,HFhospitalization. In combining group, the incidence of adverse events increased(RR=5.30,95%CI=1.72 to 16.30, P=0.004), including fever, rash,gastrointestinal trace reaction. But no serious adverse events was reported.Conclusion:The existing evidences indicate that XOI can improve cardiac function indexes. However, it had no detectable benefits on exercise capacity and clinical outcomes. The study is limited by the quality of included literatures, and the curative effect and safety of XOI should be evaluated further by more powerful RCTs.