关于沙库巴曲缬沙坦对肾功能影响的荟萃分析  

Impact of sacubitril/valsartan on renal functions:a meta-analysis

作　　者：郑少华 王真真 郑立胜 刘倩 张玉娇[2] 侯应龙[2] ZHENG Shao-hua;WANG Zhen-zhen;ZHENG Li-sheng;LIU Qian;ZHANG Yu-jiao;HOU Ying-long(Department of Cardiology,Dongying People’s Hospital,Dongying 257091,Shandong,China;Department of Cardiology,First Affiliated Hospital of Shandong First Medical University&Shandong Provincial Qianfoshan Hospital,Jinan 250014,Shandong,China)

机构地区：[1]东营市人民医院心内科,山东东营257091 [2]山东第一医科大学第一附属医院、山东省千佛山医院心内科,山东济南250014

出　　处：《心脏杂志》2023年第4期443-450,共8页Chinese Heart Journal

摘　　要：目的沙库巴曲缬沙坦(sacubitril/valsartan,S/V)在心衰治疗中的作用显著。但它对于肾功能的影响尚无定论,通过荟萃分析试图了解S/V临床应用的安全性。方法检索PubMed,EMBASE,Cochrane Library,Clinical Trials数据库。相关指标以平均差(MD)、相对危险度(RR)及95%可信区间(95%CI)表示。结果共纳入了13项随机对照试验、3项队列研究及19个无对照组观察性研究。结果显示,与肾素-血管紧张素系统抑制剂(RASi)组相比,S/V组患者肾功能恶化事件相对少(RR=0.86,95%CI:0.77~0.96,P<0.01)。高钾血症(血钾>5.5 mmol/L)事件两组无差异(RR=0.98,95%CI:0.92~1.05),而严重高钾血症(血钾>6.0 mmol/L)发生率S/V组低于RASi组(RR=0.82,95%CI:0.71~0.95,P<0.01)。无对照组观察性研究结果显示S/V治疗前后血肌酐水平及血钾水平均无明显差异。结论研究提示,S/V的肾功能安全性总体上优于RASi,但因目前大多数研究排除了CKD 4期及5期患者,故仍需更多临床研究去探索S/V在重度肾衰患者中的肾功能安全性。AIM To study the safety of clinical application of sacubitril/valsartan(S/V)through metaanalysis.METHODS We searched PubMed,EMBASE,Cochrane Library and Clinical Trials database and results were reported as mean difference(MD),relative ratio(RR)and 95%confidence interval(95%CI).RESULTS A total of 13 randomized controlled trials,3 cohort studies and 19 observational studies without control group were included.We found that worsening renal function(WRF)events in the S/V group were fewer than those in the renin-angiotensin-aldosterone system inhibitor(RASi)group(RR=0.86,95%CI:0.77~0.96,P<0.01).There was no significant difference in hyperkalemia events(blood potassium>5.5 mmol/l)between the two groups(RR=0.98,95%CI:0.92~1.05).However,the incidence of severe hyperkalemia events(blood potassium>6.0 mmol/l)in S/V group was significantly lower than that in RASi group(RR=0.82,95%CI:0.71~0.95,P<0.01).There was no significant difference in serum creatinine and potassium levels before and after S/V treatment.CONCLUSION Existing evidence has shown that S/V in general is superior to RASi in renal safety.However,since most studies have excluded patients with end stage chronic kidney disease,more clinical studies are still needed to explore its renal safety more comprehensively.

关 键 词：沙库巴曲缬沙坦 心力衰竭 肾功能不全 

分 类 号：R541.61[医药卫生—心血管疾病]