沙库巴曲缬沙坦治疗老年顽固性心力衰竭疗效优势的Meta分析  

Meta-analysis of sacubitril-valsartan versus renin-angiotensin-aldosterone system inhibitors in the treatment of elderly refractory heart failure

作　　者：苗依婷 葛亚龙 黄晶 贺雪梅 赵萱 柴程程 蒋东洋 梁英[2] MIAO Yiting;GE Yalong;HUANG Jing;HE Xuemei;ZHAO Xuan;CHAI Chengcheng;JIANG Dongyang;LIANG Ying(School of Clinical Medicine,Shandong Second Medical University,Weifang 261000,China;Department of General Practice,The First Affiliated Hospital of Shandong First Medical University&Shandong Provincial Qianfoshan Hospital,Jinan 250014,China;Department of Cardiovascular,Jinan Third Hospital,Jinan 250132,China;School of Clinical Medicine,Jining Medical University,Jining 272013,China)

机构地区：[1]山东第二医科大学临床医学院,山东潍坊261000 [2]山东第一医科大学第一附属医院<山东省千佛山医院>全科医学科,山东济南250014 [3]济南市第三人民医院心血管内科,山东济南250132 [4]济宁医学院临床医学院,山东济宁272013

出　　处：《药学研究》2024年第4期402-408,共7页Journal of Pharmaceutical Research

摘　　要：目的系统评价沙库巴曲缬沙坦(ARNI)对比肾素-血管紧张素-醛固酮系统(RAAS)抑制剂(ACEI/ARB)在治疗老年顽固性心力衰竭(RHF)患者的疗效和安全性。方法检索英文数据库(PubMed、Embase、Web of science、Conchrane Library)及中文数据库(知网、万方、维普、CBM)中已发表的随机对照试验(RCTs),采用Cochrane风险评估工具对文献质量进行评价,采用RevMan及Stata软件进行Meta分析。结果纳入10篇文献共1118例老年RHF患者。结果显示,应用ARNI组(研究组)氨基末端脑钠尿肽前体(NT-proBNP)(MD=-282.61,95%CI-344.56~-220.66,P<0.05)、左心室舒张末期内径(LVEDD)(MD=-3.48,95%CI-4.58~-2.39,P<0.05)低于应用ACEI/ARB组(对照组);左心室射血分数(LVEF)(MD=6.35,95%CI 4.65~8.06,P<0.05)、有效率(OR=2.449,95%CI 1.851~3.241,P<0.05)明显高于对照组。两组肾功能损害、头晕、高血钾比较无差异,低血压发生率低于对照组。结论与ACEI/ARB相比,ARNI可显著改善心室重构,进一步改善老年RHF患者心功能,并且安全性良好。Objective To systematically evaluate the efficacy and safety of sacubitril-valsartan(ARNI)compared to angiotensin converting enzyme inhibitors/angiotensin II receptor antagonists(ACEI/ARB)in the treatment of elderly refractory heart failure patients.Methods The literatures were obtained in Cochrane Library,Embase,PubMed,Web of science and Chinese databases(CNKI,WanFang,VIP and CBM).After literature screening and data extraction,the quality of the included literature was evaluated using the Cochrane bias risk assessment tool.Meta analysis was conducted using RevMan and Stata software.Results A total of 10 literatures were included,with a total of 1118 elderly refractory heart failure patients including.Meta-analysis results showed that the N-terminal proBNP(NT-proBNP)(MD=-282.61,95%CI-344.56~-220.66,P<0.05),the left ventricular end-diastolic diameter(LVEDD)(MD=-3.48,95%CI-4.58~-2.39,P<0.05)in the study group were lower than those in the control group;the left ventricular ejection fraction(LVEF)(MD=6.13,95%CI 5.15~7.11,P<0.05)and effective rate(OR=2.548,95%CI 2.058~3.154,P<0.05)were significantly higher than those in the control group,respectively.The left ventricular ejection fraction(LVEF)(MD=6.35,95%CI 4.65~8.06,P<0.05)and effective rate(OR=2.449,95%CI 1.851~3.241,P<0.05)were significantly higher than those in the control group.In terms of adverse reactions,there was no difference in renal function damage,dizzy and hyperkalemia between the two groups,and the incidence of hypotension in the study group was lower than that in the control group.Conclusion Compared with ACEI/ARB,sacubitril-valsartan can significantly improve cardiac function,improve ventricular remodeling,and reduce myocardial tissue damage in elderly patients with refractory heart failure without significant adverse reactions.

关 键 词：顽固性心力衰竭 老年 沙库巴曲缬沙坦 肾素-血管紧张素-醛固酮系统抑制剂 META分析 

分 类 号：R541.6[医药卫生—心血管疾病]