沙库巴曲缬沙坦治疗消融术后心房颤动的疗效及安全性的Meta分析  

Efficacy and safety of sacubitril/valsartan in the treatment of atrial fibrillation after ablation:a Meta-analysis

作　　者：毕龙飞 刘瑶 余丹 淡雪川[3] 李奎[3] BI Longfei;LIU Yao;YU Dan;DAN Xuechuan;LI Kui(School of Medical and Life Sciences,Chengdu University of Traditional Chinese Medicine,Chengdu 610075,China;School of Clinical Medicine,Chengdu Medical College,Chengdu 610500,China;Department of Cardiovascular Medicine,The Second People's Hospital of Yibin,Yibin 644000,Sichuan Province,China)

机构地区：[1]成都中医药大学医学与生命科学学院,成都610075 [2]成都医学院临床医学院,成都610500 [3]宜宾市第二人民医院心血管内科,四川宜宾644000

出　　处：《医学新知》2024年第8期916-926,共11页New Medicine

摘　　要：目的系统评价沙库巴曲缬沙坦(sacubitril/valsartan,SV)治疗心房颤动(atrial fibrillation,AF)的疗效及安全性。方法计算机检索中国知网、万方、维普、PubMed、Embase、Web of Science、The Cochrane Library数据库,检索时限为建库起至2024年4月27日。由两名研究人员独立进行文献筛选、资料提取与质量评价,采用RevMan 5.4软件进行Meta分析。结果共纳入10项研究,包括8项随机对照试验,2项队列研究,共计1355例患者。试验组予以常规治疗+SV,对照组予以常规治疗或常规治疗+血管紧张素转化酶抑制剂(ACEI)/血管紧张素受体拮抗剂(ARB)。Meta分析结果显示,在接受导管射频消融术后转为窦性心律的AF患者中,与常规治疗或常规治疗+ACEI/ARB相比,常规治疗+SV能显著减少AF复发率[OR=0.35,95%CI(0.26,0.46),P<0.001],降低左心房内径[MD=-3.26,95%CI(-4.81,-1.70),P<0.001]与左心房容积指数[MD=-6.50,95%CI(-8.76,-4.25),P<0.001],提高左心室射血分数[MD=3.79,95%CI(2.17,5.41),P<0.001],降低N末端脑钠肽前体水平[MD=-106.49,95%CI(-134.71,-78.27),P<0.001],减少药物不良反应发生率[OR=0.48,95%CI(0.26,0.86),P=0.01],然而在降低血压方面两组疗效相似。结论AF患者导管消融术后应用常规治疗+SV在减少AF复发率、改善左心功能方面相较于常规治疗或常规治疗+ACEI/ARB效果更优,但在降低血压幅度方面两组无明显差异,但此结论还有待更多的高质量研究加以论证。Objective To systematically evaluate the efficacy and safety of sacubitril/valsartan(SV)in the treatment of atrial fibrillation(AF).Methods Computerized searches of PubMed,Embase,Web of Science,The Cochrane Library,CNKI,WanFang Data and VIP from the time of inception to April 27,2024 were conducted.Literature screening,data extraction and quality assessment were conducted independently by two researchers.Meta-analysis was performed using RevMan 5.4 software.Results A total of 10 studies were included,including 8 randomized controlled trials,2 cohort studies,with a cumulative total of 1355 patients.The test group was treated with conventional therapy+SV,and the control group was treated with conventional therapy or conventional therapy+angiotensin converting enzyme inhibitor(ACEI)/angiotensin receptor blockers(ARB).The results of the Meta-analysis showed that in patients with AF who converted to sinus rhythm after undergoing radiofrequency catheter ablation,compared with the conventional therapy+ACEI/ARB,the conventional therapy+SV was able to significantly reduce the recurrence rate of AF[OR=0.35,95%CI(0.26,0.46),P<0.001],reduced left atrial diameter[MD=-3.26,95%CI(-4.81,-1.70),P<0.001],and left atrial volume index[MD=-6.50,95%CI(-8.76,-4.25),P<0.001],increase the level of left ventricle ejection fraction[MD=3.79,95%CI(2.17,5.41),P<0.001],decreased levels of N-terminal pro-brain natriuretic peptide[MD=-106.49,95%CI(-134.71,-78.27),P<0.001],reduce the incidence of adverse drug reactions[OR=0.48,95%CI(0.26,0.86),P=0.01].However,the efficacy in lowering blood pressure was similar in both groups.Conclusion The application of conventional therapy+SV after ablation in patients with AF was more effective in reducing the recurrence rate of AF and improving left heart function compared with conventional therapy or conventional therapy+ACEI/ARB,while there was no significant difference in the magnitude of blood pressure reduction,this conclusion need to be justified by more high-quality research.

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

分 类 号：R541.75[医药卫生—心血管疾病]