钠-葡萄糖共转运蛋白2抑制剂对于心力衰竭患者心脏结构及功能影响的Meta分析  

Effects of Sodium-glucose Cotransporter 2 Inhibitors on the Cardiac Structure and Function in Patients With Heart Failure:a Meta-analysis

作　　者：武锋超 蓝庆肃 马兰虎 韩俊先 王姣 姚亚丽[3] 刁佳宇 WU Fengchao;LAN Qingsu;MA Lanhu;HAN Junxian;WANG Jiao;YAO Yali;DIAO Jiayu(Cardiology Department,Shaanxi Provincial People's Hospital,Xi'an(710068),Shaanxi,China)

机构地区：[1]陕西省人民医院心内二科,西安市710068 [2]兰州大学第一临床医学院 [3]兰州大学第一医院心内科

出　　处：《中国循环杂志》2023年第2期202-208,共7页Chinese Circulation Journal

基　　金：甘肃省卫生行业科研计划项目(GSWSDY-2015-44)。

摘　　要：目的:应用Meta分析系统评估钠-葡萄糖共转运蛋白2抑制剂(SGLT2i)对心力衰竭患者心脏重构、功能及生活质量的影响。方法:使用计算机系统检索Cochrane图书馆、Web of science、PubMed、Embase数据库,检索SGLT2i对比安慰剂对于心力衰竭患者心脏重构、功能及生活质量影响的随机对照试验。检索时限均为建库起至2021年7月2日,由两位研究者独立筛选文献并提取资料,使用Review Manager 5.4.1软件进行Meta分析。结果:共纳入13项随机对照试验,共计10083例患者。Meta分析结果表明:与安慰剂相比,使用SGLT2i对左心室质量指数、左心室舒张末期容积、左心室收缩末期容积、左心房容积指数及6分钟步行距离无明显影响,仅改善了射血分数降低的心力衰竭患者的左心室舒张末期容积[均数差(MD)=-20.08,95%CI:-27.96~-12.20,P<0.0001,I^(2)=0%]、左心室收缩末期容积(MD=-19.29,95%CI:-32.81~-5.77,P=0.005,I^(2)=75%)。SGLT2i显著改善了总体心力衰竭患者的堪萨斯城心肌病患者生活质量量表(KCCQ)评分(MD=2.02,95%CI:1.36~2.68,P<0.00001,I^(2)=17%)、N末端B型利钠肽原(NT-proBNP;MD=-177.42,95%CI:-227.58~-127.27,P<0.00001,I^(2)=11%)水平。结论:SGLT2i的使用与心力衰竭患者血浆NT-proBNP水平及KCCQ评分的显著改善相关,但并不影响心脏结构参数及6分钟步行距离。左心室舒张末期容积及左心室收缩末期容积水平仅在射血分数降低的心力衰竭患者中得到改善。Objectives:To evaluate the effects of sodium-glucose cotransporter 2 inhibitors(SGLT2i)on cardiac remodeling,function and quality of life in patients with heart failure.Methods:We used computer systems to search the Cochrane Library,Web of science,PubMed,and Embase databases for randomized controlled trials evaluating the effects of SGLT2i versus placebo on cardiac remodeling,function and quality of life in patients with heart failure.The search range is from the inception of the databases to July 2,2021.Two researchers independently screened the literature and extracted the data.The Review Manager 5.4.1 software was used for meta-analysis.Results:A total of 13 randomized controlled trials were included,with a total of 10083 patients.Meta-analysis results showed that compared with placebo,the use of SGLT2i did not affect left ventricular mass index,left ventricular end-diastolic volume,left ventricular end-systolic volume,left atrial volume index and 6-minute walking distance,but significantly reduced left ventricular end-diastolic volume(mean difference[MD]=-20.08,95%CI:-27.96 to-12.20,P<0.0001,I^(2)=0%)and left ventricular end-systolic volume(MD=-19.29,95%CI:-32.81 to-5.77,P=0.005,I^(2)=75%)in heart failure patients with reduced left ventricular ejection fraction.SGLT2i also significantly improved the Kansas City Cardiomyopathy Quality of Life Scale(KCCQ)score(MD=2.02,95%CI:1.36 to 2.68,P<0.00001,I^(2)=17%),and reduced N-terminal pro-B-type natriuretic peptide(NT-proBNP;MD=-177.42,95%CI:-227.58 to-127.27,P<0.00001,I^(2)=11%).Conclusions:The present analysis shows that the use of SGLT2i is associated with a significant reduction in plasma NT-proBNP levels and improvement of KCCQ scores in patients with heart failure but does not affect cardiac structural parameters and 6-minute walking distance.Left ventricular end-diastolic volume and left ventricular end-systolic volume are reduced in heart failure patients with reduced ejection fraction.

关 键 词：钠-葡萄糖共转运蛋白2抑制剂 心力衰竭 心脏重构 META分析 

分 类 号：R54[医药卫生—心血管疾病]