依普利酮治疗高血压病疗效和安全性的Meta分析  

A Meta-analysis on efficacy and safety of eplerenone in treatment of hypertension

作　　者：丁进叶 龚斐[1] 吴慧婷[1] 钱成[1] 王扬淦[1] 

机构地区：[1]武汉大学中南医院心内科,武汉430071

出　　处：《中国循证心血管医学杂志》2016年第3期267-272,共6页Chinese Journal of Evidence-Based Cardiovascular Medicine

摘　　要：目的系统评价依普利酮治疗原发性高血压病的临床疗效与安全性。方法计算机检索Pub Med、Embase、Cochrane图书馆、CNKI、CBM、万方、维普数据库,搜索关于依普利酮治疗原发性高血压病的随机对照试验,检索时间为建库至2015年9月,由两名研究员根据纳入和排除标准独立筛选文献、提取资料和评价方法学质量,应用Rev Man5.2软件进行Meta分析。结果共纳入13篇文献,共计3795例患者。Meta分析结果显示,降压疗效方面,与安慰剂组相比,依普利酮能够降低收缩压(WMD=-8.99mm Hg,95%CI:-10.62^-7.37,P<0.00001)和舒张压(WMD=-4.21 mm Hg,95%CI:-5.07^-3.34,P<0.00001)(1mm Hg=0.133k Pa);与其他类型降压药物相比,依普利酮的降压效果次于螺内酯(收缩压:WMD=6.40 mm Hg,95%CI:6.12~6.68,P<0.00001;舒张压:WMD=3.10 mm Hg,95%CI:2.82~3.38,P<0.00001),与依那普利相当(收缩压:WMD=-0.47 mm Hg,95%CI:-3.12~2.18,P=0.73;舒张压:WMD=0.79 mm Hg,95%CI:-0.58~2.16,P=0.26),但优于血管紧张素受体拮抗剂类(收缩压:WMD=-3.51 mm Hg,95%CI:-5.20^-1.82,P<0.0001;舒张压:WMD=-2.06 mm Hg,95%CI:-2.97^-1.14,P<0.0001);安全性方面,依普利酮的总不良反应和严重不良反应发生率与各组相比差异无统计学意义。结论当前证据表明依普利酮治疗原发性高血压病是相对安全、有效的。Objective To review systematically the clinical efficacy and safety of eplerenone in treatment of essential hypertension （EH）. Methods The databases of PubMed, EMbase, Cochrane Library, CNKI, CBM, WanFang Database and VIP Database were retrieved with computer for searching randomized controlled trials （RCT） of treatment of EH with eplerenone from the time of database establishment up to Sept. 2015. The documents of RCT were screened according to inclusion and exclusion criteria, data was extracted and quality was reviewed by 2 researchers independently, and a Meta-analysis was conducted by using RevMan5.2 software. Results There were totally 13 documents included involved 3795 cases. The results of Meta-analysis showed that eplerenone reduced systolic blood pressure （SBP, WMD=-8.99 mmHg, 95%CI： -10.62- -7.37, P〈0.O0001） and diastolic blood pressure （DBP, WMD=-4.21 mmHg, 95%CI： -5.07- -3.34, P〈0.00001） compared with placebo. Compared with other anti-hypertension drugs, eplerenone was worse than spirolactone （SBP： WMD=6.40 mmHg, 95%CI： 6.12-6.68, P〈0.00001; DBP： WMD=3.10 mmHg, 95%C1： 2.82-3.38, P〈0.00001）, was similar to enalapril （SBP： WMD=-0.47 mmHg, 95%CI： -3.12-2.18, P=0.73; DBP： WMD=0.79 mmHg, 95%Ch -0.58-2.16, P=0.26）, and was better than angiotensin receptor blockers （SBP： WMD=-3.51 mmHg, 95%CI： -5.20- -1.82, P〈0.0001; DBP： WMD=-2.06 mmHg, 95%Ch -2.97- -1.14, P〈0.0001）. The difference in totally incidence of adverse reactions and severe adverse reactions had no statistical significance among all groups. Conclusion Current evidence shows that eplerenone is relatively safe and effective in the treatment of EH.

关 键 词：高血压 依普利酮 META分析 

分 类 号：R544.1[医药卫生—心血管疾病]