沙库巴曲缬沙坦治疗心房颤动的有效性和安全性:荟萃分析及系统综述  

Efficacy and safety of sacubitril-valsartan in patients with atrial fibrillation: a meta analysis and systematic review

作　　者：张占欣 高学英 王帅[1] 靳雅琼[1] 肖冰[1] 刘凡[1] 鲁静朝[1] Zhang Zhanxin;Gao Xueying;Wang Shuai;Jin Yaqiong;Xiao Bing;Liu Fan;Lu Jingchao(The Second Department of Cardiovascular Medicine,The Second Hospital of Hebei Medical University,Shijiazhuang 050000,China)

机构地区：[1]河北医科大学第二医院心血管内二科,石家庄050000

出　　处：《中华心律失常学杂志》2023年第1期44-50,共7页Chinese Journal of Cardiac Arrhythmias

基　　金：2015-2017河北省科技支撑计划 (15277770D)。

摘　　要：目的通过荟萃分析评价沙库巴曲缬沙坦(ARNI)治疗心房颤动的临床疗效。方法在Pubmed、Embase、Cochrane Library、ClinicalTrials.gov、Web of Science、Google Scholar、中国知网(CNKI)、万方数据和维普等数据库中,计算机检索自建库至2022年4月30日发表的ARNI治疗心房颤动的临床研究。主要结局指标为心房颤动复发风险、N末端脑钠肽前体(NT-proBNP)水平改变、心功能改变[左心房内径(LAD)、左心房容积指数(LAVI)、左心室射血分数(LVEF)]、血压下降幅度。采用RevMan 5.3统计软件进行荟萃分析。结果纳入4项临床试验,共462例患者。荟萃分析结果显示,在接受药物复律、电复律或导管消融后转为窦性心律的心房颤动患者中,相比于传统药物联合血管紧张素转换酶抑制剂(ACEI)/血管紧张素受体拮抗剂(ARB)类药物,传统药物联合ARNI治疗组的心房颤动复发率明显下降(68.9%对75.6%,P=0.043);左心功能改善更显著[LAD:加权均方差(WMD)=-3.57,95%CI-5.26~-1.89,P<0.001;LAVI:WMD=-5.08,95%CI-7.63~-2.53,P<0.001;LVEF:WMD=1.69,95%CI 0.15~3.23,P=0.030];NT-proBNP下降幅度相似(WMD=-223.65,95%CI-459.37~-12.06,P=0.060);血压下降幅度相似(收缩压:WMD=-1.47,95%CI-8.26~5.32,P=0.670)。结论在接受药物复律、电复律或导管消融后转为窦性心律的心房颤动患者中,传统药物联合ARNI可显著降低心房颤动复发率、逆转心肌重构,且安全性相似。Objective To systematically review the effect of sacubitril-valsartan in patients with atrial fibrillation(AF).Methods In databases such as Pubmed,Embase,Cochrane Library,ClinicalTrials.gov,Web of Science,Google Scholar,CNKI,Wanfang,and VIP,we searched the clinical studies of sacubitril-valsartan in treating AF,which were published from the establishment of the library to 30th April 2022.The primary outcome were the risk of AF recurrence,changes in N-terminal pro B-type natriuretic peptide(NT-proBNP)levels,changes in cardiac function[left atrial diameter(LAD),left atrial volume index(LAVI),left ventricular ejection fraction(LVEF)],the extent of blood pressure drop.Meta-analysis was performed using RevMan 5.3 statistical software.Results Four clinical trials with a total of 462 patients were included.Meta-analysis results show that in patients with AF converted to sinus rhythm after receiving drugs,electrical cardioversion,or catheter ablation,compared with the group treated with traditional drug in combination with angiotensin converting enzyme inhibitors(ACEI)/angiotensin receptor antagonists(ARB),the recurrence rate of AF in the sacubitril-valsartan group was significantly reduced(68.9%vs.75.6%,P=0.043);cardiac function improved significantly[LAD:weighted mean difference(WMD)=-3.57,95%CI-5.26--1.89,P<0.001;LAVI:WMD=-5.08,95%CI-7.63--2.53,P<0.001;LVEF:WMD=1.69,95%CI 0.15-3.23,P=0.030];the decrease in NT-proBNP level was similar(WMD=-223.65,95%CI-459.37--12.06,P=0.060);the decrease in blood pressure was similar(systolic blood pressure:WMD=-1.47,95%CI-8.26-5.32,P=0.670).Conclusions In patients with AF who were converted to sinus rhythm after receiving drug cardioversion,electrical cardioversion,or catheter ablation,traditional drugs combined with sacubitril-valsartan can significantly reduce the recurrence rate of AF and reverse myocardial remodeling,with similar security.

关 键 词：心房颤动 沙库巴曲缬沙坦 血管紧张素转换酶抑制剂 血管紧张素受体拮抗剂 荟萃分析 

分 类 号：R541.75[医药卫生—心血管疾病]