β受体阻滞剂在预防接受蒽环类药物的乳腺癌患者心脏毒性中的疗效：一项采用试验序贯分析的GRADE评级系统评价与荟萃分析。
完整摘要 · 中文译文
目的：蒽环类药物诱导的心脏毒性仍是接受全身治疗的乳腺癌患者的重要并发症，有效的预防策略仍然有限。我们进行了一项系统评价和荟萃分析，以评估β受体阻滞剂在蒽环类药物治疗的乳腺癌患者中的心脏保护作用。 方法：遵循PRISMA指南，系统检索了Pubmed、Web of Science、CINAHL和Cochrane，方案已在PROSPERO预注册（CRD420261366946）。主要结局为左心室射血分数（LVEF），次要结局为E/A比值。采用GRADE方法和试验序贯分析（TSA）评估证据的确定性和稳健性。使用R 4.6.0版进行荟萃分析，采用I 2统计量评估异质性。 结果：共分析8项研究，纳入772例患者。与安慰剂或标准治疗相比，β受体阻滞剂治疗与LVEF的显著保留相关（MD，2.85；95% CI，0.58-5.12；p = 0.02；I 2 95%）。E/A比值未见显著改善（MD，0.10；95% CI，-0.12至0.31；p = 0.25；I 2 69.7%）。然而，敏感性分析得出了具有统计学意义的合并效应（MD = 0.16，95% CI：0.03至0.29，p = 0.01；I 2 = 35.9%）。TSA显示Z曲线跨越了支持β受体阻滞剂对LVEF获益的监测边界；然而，未达到所需信息量（RIS = 1,785）。 结论：在蒽环类药物治疗的……患者中，β受体阻滞剂与收缩功能的保留相关 乳腺癌患者。然而，未观察到E/A比值的显著获益，关于舒张功能保护的证据仍无定论。需要更大规模、高质量的随机对照试验（RCT）来证实这些发现。 系统综述注册：标识符 CRD420261366946。
完整摘要 · 英文原文
PURPOSE: Anthracycline-induced cardiotoxicity remains an important complication in patients with breast cancer receiving systemic therapy, and effective preventive strategies remain limited. We conducted a systematic review and meta-analysis to evaluate the cardioprotective effects of beta-blockers in anthracycline-treated breast cancer patients. METHODS: Following PRISMA guidelines, Pubmed, Web of Science, CINAHL, and Cochrane were systematically searched, and the protocol was preregistered on PROSPERO (CRD420261366946). The primary outcome was left ventricular ejection fraction (LVEF), while the secondary outcome was E/A ratio. Certainty and robustness of the evidence were assessed using GRADE approach and trial sequential analysis (TSA). A meta-analysis was performed using R version 4.6.0, and heterogeneity was assessed using I 2 statistics. RESULTS: A total of 8 studies including 772 patients were analyzed. Beta-blocker therapy was associated with significant preservation of LVEF vs. placebo or standard care (MD, 2.85; 95% CI, 0.58-5.12; p = 0.02; I 2 95%). No significant improvement was observed for E/A ratio (MD, 0.10; 95% CI, -0.12 to 0.31; p = 0.25; I 2 69.7%). However, sensitivity analysis resulted in a statistically significant pooled effect (MD = 0.16, 95% CI: 0.03 to 0.29, p = 0.01; I 2 = 35.9%). TSA showed that the Z-curve crossed the monitoring boundaries favoring beta-blockers for LVEF; however, the required information size (RIS = 1,785) was not reached. CONCLUSION: Beta-blockers were associated with preservation of systolic function in anthracycline-treated breast cancer patients. However, no significant benefit was observed for E/A ratio, and evidence regarding diastolic protection remains inconclusive. Larger, high-quality RCTs are needed to confirm these findings. SYSTEMATIC REVIEW REGISTRATION: identifier CRD420261366946.