醛固酮受体拮抗剂治疗舒张性心衰疗效及安全性的Meta分析  

Efficacy and Safety of Aldosterone Receptor Antagonists in the Treatment of Diastolic Heart Failure:A Meta-Analysis

作　　者：何倩雯[1] 文印宪[2] 冯英[1] 周游[1] 王扬淦[1] 

机构地区：[1]武汉大学中南医院心血管内科,湖北武汉430071 [2]武汉大学中南医院骨科,湖北武汉430071

出　　处：《武汉大学学报（医学版）》2015年第4期668-672,共5页Medical Journal of Wuhan University

基　　金：国家自然科学基金资助项目(编号:81270304;81420108004)

摘　　要：目的:对醛固酮受体拮抗剂治疗舒张性心衰的疗效及安全性进行Meta分析。方法:计算机检索PubMed、EMbase、The Cochrane Library、CNKI、WanFang Data、VIP、CBM数据库,查找醛固酮受体拮抗剂治疗舒张性心衰的随机对照试验。由两位研究者独立筛选文献、提取资料、评价方法学质量后,采用RevMan 5.2软件进行Meta分析。结果:共纳入10个研究,共计4 376例患者。Meta分析结果显示,醛固酮受体拮抗剂能显著改善舒张性心衰患者的临床疗效[RR=1.41,95%CI(1.16,1.71),P=0.000 5]、运动耐量[6 min步行距离:MD=69.86,95%CI(3.42,136.31),P=0.04]和左室舒张功能[E/E’值:MD=-2.22,95%CI(-3.57,-0.86),P=0.001],降低血浆BNP水平[MD=-82.47,95%CI(-91.92,-73.02),P<0.000 01]和Ⅲ型胶原蛋白氨基端多肽水平[MD=-0.87,95%CI(-1.46,-0.27),P=0.004]。结论:当前证据显示,醛固酮受体拮抗剂能使舒张性心衰患者明显受益。Objective. To systematically evaluate the efficacy and safety of aldosterone receptor antago- nists （ARAs） in patients with diastolic heart failure （DHF）. Methods. PubMed, EMbase, the Cochrane Library, CNKI, WanFang Data, VIP, and CBM were searched for randomized con- trolled trials investigating the effects of ARAs in DHF patients. Two reviewers independently screened the literature, extracted data, and assessed the methodological quality of included stud- ies. The meta-analysis was conducted by using RevMan 5.2 software. Results. Ten studies invol- ving 4 376 patients were included in the meta-analysis. ARAs administration resulted in a signifi- cant improvement of efficacy （RR= 1.41,95% CI [1.16,1.71], P = 0. 000 5）, exercise capacity （MD of 6-minute walk distance = 69.86,95% CI [3.42,136.31], P = 0.04） and diastolic function （MD of E/E＇ ratio=-2. tion, ARAs decreased the 22,95% CI [-3.57,-0.86],P=0.001） in DHF patients. In addi- serum BNP level （ADD=-82.47, 95% CI [-91.92,-73.02],P〈0.000 01） andPIHNPlevel （MD=-0.87,95% C1[-1. 46,-0. 27],P=0. 004）. Conclusion： Current evidence shows that ARAs are beneficial to DHF patients.

关 键 词：舒张性心衰 射血分数保留的心衰 醛固酮受体拮抗剂 META分析 

分 类 号：R541.6[医药卫生—心血管疾病]