沙库巴曲缬沙坦对比肾素-血管紧张素-醛固酮系统阻滞剂治疗心力衰竭合并肾功能不全疗效的系统评价  

Systematic Review on Comparison of Efficacy Between Sacubitril Valsartan and Renin-Angiotensin-Aldosterone System Blockers in the Treatment of Heart Failure Complicated with Renal Insufficiency

作　　者：李鎛江 李倩倩 胡祥[1] 潘红霞[1] 董建华[1] 鲍永强[1] 傅一星 肖友文[1] LI Bojiang;LI Qianqian;HU Xiang;PAN Hongxia;DONG Jianhua;BAO Yongqiang;FU Yixing;XIAO Youwen(Dept.of Nephrology,Leshan People’s Hospital,Sichuan Leshan 614000,China;Dept.of Pediatric Respiratory Medicine,Chengdu Women’s and Children’s Central Hospital,Chengdu 610031,China)

机构地区：[1]乐山市人民医院肾病内科,四川乐山614000 [2]成都市妇女儿童中心医院儿童呼吸内科,成都610031

出　　处：《中国医院用药评价与分析》2022年第8期990-995,共6页Evaluation and Analysis of Drug-use in Hospitals of China

摘　　要：目的:系统评价沙库巴曲缬沙坦对比肾素-血管紧张素-醛固酮系统(RAAS)阻滞剂治疗心力衰竭合并肾功能不全的疗效。方法:截至2021年5月28日,对8个电子数据库进行系统的文献检索,搜集沙库巴曲缬沙坦(研究组)与RASS阻滞剂(对照组)治疗心力衰竭合并肾功能不全的随机对照试验,采用Cochrane手册推荐的偏倚风险衡量工具评估纳入文献的质量,采用RevMan 5.3软件进行Meta分析。结果:共纳入8篇随机对照试验文献(3575例患者)。分析结果显示,研究组患者的心力衰竭治疗有效率显著优于对照组(RR=1.16,95%CI=1.07~1.26,P=0.0002),研究组患者肾小球滤过率(MD=3.09,95%CI=1.46~4.73,P=0.0002)、氨基末端脑钠肽前体(MD=-309.93,95%CI=-556.77~-63.10,P=0.01)、左心室射血分数(MD=4.51,95%CI=3.69~5.34,P<0.00001)、左心室收缩末期内径(MD=-4.75,95%CI=-5.63~-3.86,P<0.00001)和左心室舒张末期内径(MD=-5.02,95%CI=-6.32~-3.72,P<0.00001)的改善程度均显著优于对照组,上述差异均有统计学意义。结论:沙库巴曲缬沙坦对心力衰竭合并肾功能不全患者的心肾保护作用可能优于RAAS阻滞剂。OBJECTIVE:To systematically review the comparison of efficacy between sacubitril valsartan and renin-angiotensin-aldosterone system(RAAS)blockers in the treatment of heart failure complicated with renal insufficiency.METHODS:Randomized controlled trials of sakubatril valsartan(research group)versus RASS blockers(control group)in the treatment of heart failure complicated with renal insufficiency were systematically retrieved from 8 electronic databases until May 28,2021,the quality of included literature were assessed by using the risk of bias measure tool recommended by the Cochrane Handbook,and Meta-analysis was conducted by using RevMan 5.3 software.RESULTS:A total of 8 randomized controlled trials(including 3575 patients)were involved.Results of the analysis showed that patients in the research group had significantly better effective rate of heart failure than that of the control group(RR=1.16,95%CI=1.07-1.26,P=0.0002),the research group had more significantly improved glomerular filtration rate(MD=3.09,95%CI=1.46-4.73,P=0.0002),amino-terminal pro-brain natriuretic peptide(MD=-309.93,95%CI=-556.77--63.10,P=0.01),left ventricular ejection fraction(MD=4.51,95%CI=3.69-5.34,P<0.00001),left ventricular end-systolic diameter(MD=-4.75,95%CI=-5.63--3.86,P<0.00001)and left ventricular end-diastolic diameter(MD=-5.02,95%CI=-6.32--3.72,P<0.00001)than those of the control group,with statistically significant differences.CONCLUSIONS:The cardiorenal protective effect of sakubatril valsartan in patients with heart failure complicated with renal insufficiency may be superior to that of RAAS blockers.

关 键 词：沙库巴曲缬沙坦 肾素-血管紧张素-醛固酮系统阻滞剂 肾功能不全 心力衰竭 META分析 

分 类 号：R972[医药卫生—药品]