SGLT2抑制剂治疗射血分数降低的心力衰竭的疗效和安全性的Meta分析  

A meta-analysis of the efficacy and safety of SGLT2 inhibitors in the treatment of heart failure with reduced ejection fraction

作　　者：武锋超 蓝庆肃 马兰虎 韩俊先 王娇 吴波 姚亚丽[2] Wu Fengchao;Lan Qingsu;Ma Lanhu;Han JunXian;Wang Jiao;Wu Bo;Yao Yali(The First Clinical Medical College,Lanzhou University,Lanzhou 730000 Gansu,China;不详)

机构地区：[1]兰州大学第一临床医学院,兰州730000 [2]兰州大学第一医院,兰州730000

出　　处：《中国循证心血管医学杂志》2022年第8期915-919,926,共6页Chinese Journal of Evidence-Based Cardiovascular Medicine

摘　　要：目的 系统评价钠葡萄糖协同转运体2抑制剂(SGLT2i)治疗射血分数降低的心力衰竭(HFr EF)的有效性和安全性(不管是否存在2型糖尿病)。方法 我们系统检索了Cochrane图书馆、Web of science、PubMed、Embase数据库,检索时限均为建库起至2020年12月21日,检索了SGLT2i对比安慰剂治疗HFr EF随机对照试验的数据,收集心力衰竭住院、全因死亡、心血管死亡、心力衰竭住院或心血管死亡复合风险、堪萨斯城心肌病患者生活质量量表(KCCQ)、收缩压和不良事件的数据进行分析。采用Cochrane偏倚风险评估工具对纳入文献质量进行评价,使用Review Manager 5.4.1软件进行Meta分析,使用Stata14.0评价发表偏倚。结果 共纳入7项RCT,共计10 181例患者。与安慰剂相比,使用SGLT2i显著降低了心力衰竭住院(HR=0.70,95%CI:0.62~0.78,P<0.00001)、心血管死亡(HR=0.84,95%CI:0.74~0.95;P=0.006)、全因死亡(HR=0.85,95%CI:0.76~0.94,P=0.003)、心力衰竭住院或心血管死亡复合风险(HR=0.74,95%CI:0.68~0.81,P<0.00001)。使用SGLT2i的患者在KCCQ评分和收缩压方面也有显著改善。SGLT2i虽然增加了生殖器感染风险(RR=2.09,95%CI:1.26~3.47,P=0.004),但总体上没有增加其他不良反应发生风险(包括截肢、骨折、急性肾损伤等)。结论 该研究分析表明,不管是否存在T2DM,SGLT2i可降低HFr EF患者心力衰竭住院、心血管死亡及全因死亡风险,并改善心力衰竭症状,且不良事件的发生率相似。Objective To systematically review the efficacy and safety of sodium glucose transporter 2 inhibitors(sglt2i) in the treatment of heart failure with reduced ejection fraction(regardless of whether there is type 2 diabetes). Methods We systematically searched the Cochrane Library, Web of science, PubMed, and Embase databases. The search time limit was from the establishment of the database to December 21, 2020. The data of the randomized controlled trial of SGLT2i versus placebo in the treatment of HFr EF was retrieved. The data of failure hospitalization, all-cause death, cardiovascular death, heart failure hospitalization or cardiovascular death compound risk, Kansas City Cardiomyopathy Patient Quality of Life Scale(KCCQ), systolic blood pressure and adverse events were analyzed. The Cochrane bias risk assessment tool was used to evaluate the quality of the included literature, the Review Manager 5.4.1 software was used for Meta analysis,and the Stata 14.0 was used to evaluate publication bias. Results A total of 7 randomized controlled trials were included, with a total of 10181patients. Compared with placebo, the use of SGLT2i significantly reduced hospitalizations for heart failure(HR=0.70,95%CI: 0.62~0.78, P<0.00001), cardiovascular death(HR=0.84, 95%CI: 0.74~0.95, P=0.006], all-cause death(HR=0.85, 95%CI: 0.76~0.94, P=0.003), compound risk of heart failure hospitalization or cardiovascular death(HR=0.74, 95%CI: 0.68~0.81, P<0.00001);In addition, patients using SGLT2i also had significant improvements in KCCQ score and systolic blood pressure. Although SGLT2i increased the risk of genital infection(RR=2.09,95%CI: 1.26~3.47, P=0.004), However, it did not increase the risk of other adverse reactions(including amputation,fracture, acute kidney injury, etc.). Conclusion This meta-analysis shows that regardless of the presence of T2DM,SGLT2i can reduce the risk of hospitalization, cardiovascular death and all-cause death in HFr EF patients with heart failure, and improve the symptoms of heart failure,and the inci

关 键 词：钠葡萄糖协同转运体2抑制剂 射血分数降低的心力衰竭 META分析 

分 类 号：R541.61[医药卫生—心血管疾病]