托伐普坦治疗心力衰竭合并利尿剂抵抗疗效的Meta分析  

Efficacy evaluation of tolvaptan in the treatment of heart failure combined with diuretic resistance:a Meta-analysis

作　　者：张亚同[1] 郑丽[2] 朱翊[1] 车宁[1] 李铮[1] ZHANG Ya-tong;ZHENG Li;ZHU Yi;CHE Ning;LI Zheng(Department of Pharmacy,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Pharmacy,No.731 Hospital of CASIC,Beijing 10074,China)

机构地区：[1]北京医院药学部国家老年医学中心中国医学科学院老年医学研究院,北京100730 [2]中国航天科工集团七三一医院药剂科,北京100074

出　　处：《临床药物治疗杂志》2020年第9期36-41,共6页Clinical Medication Journal

摘　　要：目的系统评价心力衰竭(HF)合并利尿剂抵抗的患者应用托伐普坦与利尿剂的疗效。方法系统检索Embase、PubMed、Medline、Clinical Key、Google学术、中国期刊全文数据库、中国生物医学文献数据库及万方数据库,检索时限均为从建库至2018年11月30日。搜集有关HF合并利尿剂抵抗患者应用托伐普坦与传统利尿剂治疗的疗效比较随机对照试验(RCT),采用RevMan 5.3软件进行Meta分析。结果纳入10项RCT共724例患者。Meta分析结果显示:与对照组(传统利尿剂组)比较,观察组(托伐普坦组)尿量(MD=1.36,95%CI:0.67~2.05,P<0.05)增加,肌酐(MD=-0.36,95%CI:-0.58^-0.13,P<0.05)升高,均有明显改善,血钠(MD=0.65,95%CI:0.45~0.85,P<0.05)增加,氨基末端脑钠肽前体(MD=-1.27,95%CI:-1.49^-1.04,P<0.05)降低,左室射血分数(MD=8.50,95%CI:7.64~9.35,P<0.05)增加。结论 HF合并利尿剂抵抗的患者使用托伐普坦(15 mg/d)可有效减轻液体潴留、改善肾功能及心功能、纠正低钠血症,对于临床患者获益明显。Objective To systematically evaluate the efficacy of tolvaptan and diuretics alone in patients with heart failure(HF)and diuretic resistance. Methods The databases including Embase,PubMed,Medline,Clinical Key,Google Scholar,CNKI,CBM and Wanfang databases were searched,the retrieval time was up to November 30,2018. Randomized controlled trials(RCTs)comparing the efficacy of tolvaptan with diuretic therapy in patients with HF and diuretic resistance were collected. Then Meta-analysis was performed using RevMan software 5. 3. Results A total of 724 patients were enrolled in 10 RCTs.Meta-analysis showed that compared with the diuretic group,the amount of urine in the tolvaptan group(MD=1. 36,95%CI:0. 67-2. 05,P<0. 05) increased,creatinine(MD=-0. 36,95%CI:-0. 58^-0. 13,P<0. 05)were significantly improved,blood sodium(MD=0. 65,95%CI:0. 45-0. 85,P<0. 05)increased,NT-proBNP value(MD=-1. 27,95%CI:-1. 49^-1. 04,P<0. 05)decreased,and LVEF(MD=8. 50,95%CI:7. 64-9. 35,P<0. 05)increased. Conclusion The choice of tolvaptan(15 mg/d)in patients with heart failure and diuretic resistance can effectively reduce fluid retention,improve renal function and heart function,and correct hyponatremia,which is beneficial to clinical patients.

关 键 词：托伐普坦 利尿剂抵抗 心力衰竭 利尿剂 META分析 

分 类 号：R541.6[医药卫生—心血管疾病] R972.1[医药卫生—内科学]