沙库巴曲缬沙坦对比ACEI/ARB治疗心梗后心衰有效性和安全性的Meta分析  

Meta-analysis of the effectiveness and safety of sacubitril valsartan compared to ACEI/ARB in the treatment of post myocardial infarction heart failure

作　　者：郭红鑫 李兴渊[2] 朱明军[2] GUO Hong-xin;LI Xing-yuan;ZHU Ming-jun(Department of First Clinical Medical College,Henan University of Chinese Medicine,Henan Zhengzhou 450000,China;Department of Cardiovascular Diseases,First Affiliated Hospital of Henan University of Chinese Medicine,Henan Zhengzhou 450004,China)

机构地区：[1]河南中医药大学第一临床医学院,河南郑州450000 [2]河南中医药大学第一附属医院心脏中心,河南郑州450004

出　　处：《中国医院药学杂志》2023年第1期65-74,共10页Chinese Journal of Hospital Pharmacy

基　　金：国家重点研发计划重点专项课题(编号:2019YFC1710003,2019YFC1710000);国家自然科学基金重点项目(编号:82030120)。

摘　　要：目的:系统评价沙库巴曲缬沙坦(sacubitril valsartan, SV)对比血管紧张素转化酶抑制剂(angiotensin converting enzyme inhibitors, ACEI)或血管紧张素受体拮抗剂(angiotensin receptor blockers, ARB)治疗心梗后心衰(post myocardial infarction heart failure, P-MI-HF)的有效性与安全性。方法:检索中国知网和PubMed等数据库自建库起至2021年12月有关SV(试验组)对比ACEI/ARB(对照组)治疗P-MI-HF的随机对照研究(randomised controlled trial, RCT)。采用Cochrane评价手册对纳入文献质量进行评价,采用Stata 14.0软件进行Meta分析。结果:共纳入15项RCT,Meta分析结果显示,试验组患者在左室射血分数[WMD=5.53,95%CI(3.93,7.13),P<0.01]、左室舒张末内径[WMD=-2.91,95%CI(-4.05,-1.77),P<0.01]、N末端B型利钠肽原[WMD=-358.40,95%CI(-446.62,-270.19),P<0.01]、6分钟步行试验[WMD=66.57,95%CI(21.29,111.84),P<0.01]和主要不良心血管事件发生率[RR=0.58,95%CI(0.45,0.74),P<0.01]方面均优于对照组,且安全性良好。亚组分析结果显示行经皮冠状动脉介入治疗组的效果更好。结论:SV治疗P-MI-HF在提高患者心功能、改善心室重构和远期预后等方面较ACEI/ARB效果更优,且安全性良好。但由于纳入研究总体质量一般,该结果有待更严谨的RCT进一步证明。OBJECTIVE To systematically evaluate the efficacy and safety of sacubitril valsartan(SV) compared to angiotensin-converting enzyme inhibitors(ACEI) or angiotensin receptor blockers(ARB) in the treatment of post myocardial infarction heart failure(P-MI-HF).METHODS Databases such as CNKI and PubMed were searched for randomized controlled trials(RCTs) on SV(experiment group) or ACEI/ARB(control group) in the treatment of P-MI-HF from inception to December 2021. Bias risk assessment tool recommended by the Cochrane handbook was used to evaluate the quality of the included literature, and Stata 14.0 software was used for Meta-analysis.RESULTS A total of 15 RCTs were included. Meta-analysis results showed that the left ventricular ejection fraction [WMD =5.53, 95%CI(3.93, 7.13), P<0.01], left ventricular end-diastolic diameter [WMD=-2.91, 95% CI(-4.05,-1.77), P<0.01], N-terminal pro-B-type natriuretic peptide [WMD=-358.40, 95% CI(-446.62,-270.19), P<0.01], 6-minute walk test [WMD=66.57, 95% CI(21.29, 111.84), P<0.01] and incidence of major adverse cardiovascular events [RR =0.58, 95%CI(0.45, 0.74), P<0.01] in the experiment group were all better than those in the control group, and the safety was promising. Subgroup analysis showed better outcomes in the percutaneous coronary intervention group.CONCLUSION The treatment of P-MI-HF with SV is more effective than ACEI/ARB, and it has high safety. However, due to the overall low quality of the included studies, this results need to be further demonstrated in more rigorous RCTs.

关 键 词：沙库巴曲缬沙坦 ACEI ARB 心肌梗死 心力衰竭 META分析 

分 类 号：R972[医药卫生—药品]