沙库巴曲缬沙坦对急性心肌梗死后不良心血管事件及心功能影响的Meta分析  

The effects of sacubitril/valsartan on adverse cardiovascular events and cardiac function after acute myocardial infarction:a Meta analysis

作　　者：冯娟 闫奎坡[2] 朱翠玲[2] 朱明军[2] 孙彦琴[2] 徐亚洲[2] 郭雨晴 刘刚[2] FENG Juan;YAN Kuipo;ZHU Cuiling;ZHU Mingjun;SUN Yanqin;XU Yazhou;GUO Yuqing;LIU Gang(He'nan University of Chinese Medicine,Zhengzhou,450000,China;Heart Center,The First Affiliated Hospital of He’nan University of Chinese Medicine)

机构地区：[1]河南中医药大学,郑州450000 [2]河南中医药大学第一附属医院心脏中心

出　　处：《临床心血管病杂志》2021年第6期531-536,共6页Journal of Clinical Cardiology

基　　金：国家自然科学基金青年基金支持项目(No:81303073);河南省首批青苗人才(No:192102310161,182102310291);河南省中医药科学研究专项课题(No:2017ZY2017);河南省中医药科学研究专项课题(No:2016ZY3003,2016ZY2051,2017ZY2017);河南省中医药科学研究专项(No:20-21ZY1015、20-21ZY2004)。

摘　　要：目的:系统评价沙库巴曲缬沙坦对急性心肌梗死后不良心血管事件和心功能的影响。方法:全面检索PubMed、Cochrane Library、EMBase、中国知网、万方、维普、CBM等从建库至2021年1月发表的沙库巴曲缬沙坦治疗急性心肌梗死的随机对照试验。2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan5.3软件进行Meta分析。结果:纳入13篇文献,共1312例患者。Meta分析显示,急性心肌梗死患者在常规治疗的基础上加用沙库巴曲缬沙坦可进一步降低不良心血管事件总发生率[RR=0.54,95%CI:(0.40,0.72),P<0.0001]和再住院率[RR=0.42,95%CI:(0.29,0.61),P<0.00001];沙库巴曲缬沙坦组恶性心律失常发生率[RR=0.70,95%CI:(0.31,1.58),P=0.39]、再发心肌梗死发生率[RR=0.67,95%CI:(0.28,1.60),P=0.37]、再发心绞痛发生率[RR=0.55,95%CI:(0.21,1.41),P=0.21]和病死率[RR=0.49,95%CI:(0.21,1.15),P=0.10]与对照组相比较差异无统计学意义;沙库巴曲缬沙坦组较对照组进一步提高左室射血分数[MD=5.26,95%CI:(4.00,6.52),P<0.00001],降低左室舒张期末内径[MD=-2.62,95%CI:(-3.31,-1.93),P<0.00001],且不增加低血压[RR=0.69,95%CI:(0.26,1.83),P=0.45]、血管性水肿[RR=0.60,95%CI:(0.15,2.46),P=0.48]和高钾血症[RR=1.00,95%CI:(0.18,5.60),P=1.00]的发生率。结论:急性心肌梗死后应用沙库巴曲缬沙坦可有效改善患者心功能,降低不良心血管事件发生率、再住院率,且无明显的不良反应。Objective:To evaluate the effects of sacubitril/valsartan on adverse cardiovascular events and cardiac function after acute myocardial infarction.Methods:We searched Pubmed,Cochrane Library,EMBase,CNKI,WanFang,VIP,CBM databases for the related randomized controlled trials from the establishment of the database to January 2021.Two reviewers screened literatures,extracted data and assessed the risk of bias of included studies.The Meta-analysis was performed by RevMan 5.3 software.Results:A total of 13 articles involving 1312 patients were included.Meta analysis showed that sacubitril/valsartan combined with conventional treatment further reduced the total incidence of adverse cardiovascular events[RR=0.54,95%CI:(0.40,0.72),P<0.0001]and rehospitalization rate[RR=0.42,95%CI:(0.29,0.61),P<0.00001].There was no difference between the sacubitril/valsartan group and the control group in the incidence of malignant ventricular arrhythmia[RR=0.70,95%CI:(0.31,1.58),P=0.39],recurrent myocardial infarction[RR=0.67,95%CI:(0.28,1.60),P=0.37],recurrent angina pectoris[RR=0.55,95%CI:(0.21,1.41),P=0.21],and mortality[RR=0.49,95%CI:(0.21,1.15),P=0.10].Compared with the control group,the sacubitril/valsartan group better increased left ventricular ejection fraction[MD=5.26,95%CI:(4.00,6.52),P<0.00001],reduced left ventricular end diastolic diameter[MD=-2.62,95%CI:(-3.31,-1.93),P<0.00001],without increasing the incidence of adverse reactions such as hypotension[RR=0.69,95%CI:(0.26,1.83),P=0.45],angioedema[RR=0.60,95%CI:(0.15,2.46),P=0.48],and hyperkalemia[RR=1.00,95%CI:(0.18,5.60),P=1.00].Conclusion:Sacubitril/valsartan can effectively improve the cardiac function of patients with acute myocardial infarction,and reduce the incidence of adverse cardiovascular events,and rehospitalization rate without obvious adverse reactions.

关 键 词：急性心肌梗死 沙库巴曲缬沙坦钠 心功能 不良心血管事件 病死率 再住院率 不良反应 

分 类 号：R542.2[医药卫生—心血管疾病]