全球射血分数保留型心力衰竭药物治疗指南的系统评价  

A systematic review of guidelines concerning pharmacological intervention for heart failure with preserved ejection fraction

作　　者：李依璇 杨贤[2] 严思敏 兰希 鲍雪 张晋萍[2] LI Yi-xuan;YANG Xian;YAN Si-min;LAN Xi;BAO Xue;ZHANG Jin-ping(Department of Pharmacy,China Pharmaceutical University Nanjing Drum Tower Hospital,Jiangsu Nanjing 210008,China;Department of Pharmacy,Nanjing Drum Tower Hospital,Affiliated Hospital of Nanjing University Medical School,Nanjing Medical Center for Clinical Pharmacy,Jiangsu Nanjing 210008,China;Department of Cardiology,Nanjing Drum Tower Hospital,Affiliated Hospital of Nanjing University Medical School,Jiangsu Nanjing 210008,China)

机构地区：[1]中国药科大学南京鼓楼医院药学部,江苏南京210008 [2]南京大学医学院附属鼓楼医院药学部,南京临床医学中心,江苏南京210008 [3]南京大学医学院附属鼓楼医院心脏科,江苏南京210008

出　　处：《中国医院药学杂志》2022年第19期2057-2063,共7页Chinese Journal of Hospital Pharmacy

摘　　要：目的:为射血分数保留型心力衰竭(heart failure with preserved ejection fraction,HFpEF)临床药物治疗实践提供参考。方法:系统检索PubMed、Embase、GIN、CBM、CNKI、Wanfang、VIP等中英文数据库,检索时限均为建库至2021年10月,按照纳入和排除标准筛选指南;使用AGREEⅡ评估工具6个领域对指南进行方法学质量评价,使用Excel 2019对药物推荐意见进行统计。结果:共入选16篇指南,11篇来自亚洲,其中2篇来自北美洲、2篇来自欧洲、1篇来自大洋洲。AGREEⅡ6个领域范围与目的""指南制订参与人员""制订的严谨性""清晰性与可读性""适用性""编辑的独立性"平均得分分别为72.55%,56.91%,43.78%,69.50%,40.65%,39.17%。药物治疗方面,指南对利尿剂的推荐频率最高,其次为盐皮质激素受体拮抗剂与血管紧张素Ⅱ受体阻滞剂。结论:纳入的包含HFpEF治疗内容指南总体方法学质量中等,在"制订的严谨性""适用性"与"编辑的独立性"方面需进一步完善。HFpEF药物治疗推荐意见以加强使用利尿剂为唯一指导性策略,血管紧张素受体脑啡肽酶抑制剂与钠-葡萄糖协同转运蛋白2抑制剂有望成为药物治疗新的参考选择。我国应积极提高方法学质量,制订高质量指南,以更好地指导HFpEF临床药物治疗实践。OBJECTIVE To provide reference for pharmacological treatment practice in heart failure with preserved ejection fraction(HFpEF).METHODS Guidelines concerning HFpEF were electronically retrieved in PubMed,Embase,GIN,CNKI,CBM,Wanfang,VIP and other medical association database.The guidelines were selected according to inclusion and exclusion criteria.Methodological quality of the guidelines was evaluated using six domains of the AGREEⅡassessment tool,and statistics of drug recommendations were performed by using Excel 2019.RESULTS Totally 16 guidelines were included with 11 from Asia,2 from North America,2 from Europe,and 1 from Oceania.The average scoring rates of the 16 guidelines in the 6 fields of AGREEⅡ,including the scope and purpose,participants,rigor of formulation,clarity of expression,applicability,and independence of editors were 72.55%,56.91%,43.78%,69.50%,40.65%and 39.17%,respectively.Recommendations for pharmacological treatment of HFpEF were dominated by the aggressive use of diuretics for symptomatic relief,followed by mineralocorticoid receptor antagonists and angiotensin receptor blockers.CONCLUSION The overall methodological quality of the guidelines is suboptimal,and further improvements are needed in terms of rigour of formulation,applicability and independence of editors.The HFpEF pharmacotherapy recommendations are based on the intensified use of diuretics as the only guiding strategy,and angiotensin receptor neprilysin inhibitor and sodium-dependent glucose transporters 2 inhibitors are expected to be the new reference options.China should improve the methodological quality,and revise high-quality guidelines to better guide pharmacological treatment practice in HFpEF.

关 键 词：射血分数保留型心力衰竭 指南 药物治疗 系统评价 

分 类 号：R972[医药卫生—药品]