比较沙库巴曲缬沙坦与血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂类药物对肾功能影响的Meta分析  

Meta-analysis of Comparing the Effects of Sacubitril/Valsartan and ACEI/ARB on Renal Function

作　　者：吕俊刚 胡凤英 张琳 王娜 翟莉 LYU Jungang;HU Fengying;ZHANG Lin;WANG Na;ZHAI Li(The Third Department of Internal Medicine,Bejing Corps Hospital of Chinese People's Armed Police Force,Bejing 100027,China;Department of Cardiovascular Medicine,Tangshan Central Hospital,Tangshan 063000,Hebei,China;Graduate School of Tianjin Medical University,Tianjin300192,China)

机构地区：[1]武警北京市总队医院内三科,北京100027 [2]唐山中心医院心血管内科,河北唐山063000 [3]天津医科大学研究生院,天津300192

出　　处：《中国分子心脏病学杂志》2024年第5期6333-6341,共9页Molecular Cardiology of China

基　　金：河北省医学科学研究课题计划项目(20221849)。

摘　　要：目的评估沙库巴曲缬沙坦与血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂(ACEI/ARB)类药物对合并或不合并心力衰竭患者肾功能的影响。方法检索the Cochrane Library、万方数据、PubMed、中国知网、Embase、Clinical Trials等主要的中英文医学数据库,检索时间均从建库至2024年1月。对于纳入的随机对照研究采用Cochrane偏倚风险评价工具对文献质量进行分析评估,并使用Review Manager 5.4系统评价分析软件进行数据分析,其中二分类变量以相对危险度(relative risk,RR)作为效应指标,根据异质性的不同分别采用固定效应模型或随机效应模型合并效应量。结果最终纳入15篇符合要求的文献,纳入文献的总患者为20155例(其中对照组10085例患者、试验组10070例患者)。与ACEI/ARB类药物相比,沙库巴曲缬沙坦组治疗后肾功能恶化(RR=0.84,95%CI:0.73~0.97,P=0.02)、终末期肾病(RR=0.53,95%CI:0.30~0.96,P=0.03)、血肌酐>2.0 mg/dL(RR=0.79,95%CI:0.68~0.91,P<0.01)、血钾>6.0 mmol/L(RR=0.80,95%CI:0.69~0.93,P<0.01)的发生率更低。但沙库巴曲缬沙坦治疗后的血管性水肿(RR=2.41,95%CI:1.23~4.71,P=0.01)的发生率更高。此外,两组患者治疗后的急性肾功能损伤、估算肾小球滤过率(eGFR)降低25%以上或50%以上、血肌酐大于2.5 mg/dL或3.0 mg/dL、高钾血症(>5.5 mmol/L)发生率无显著差异(P均>0.05)。结论沙库巴曲缬沙坦对肾脏具有较好的保护作用,可更有效地降低肾功能恶化等风险,并可能替代ACEI/ARB类药物,但因纳入研究大部分随访时间不超过1年,且大部分研究将eGFR<30 mL/(min·1.73 m^(2))的患者排除在外,因此,沙库巴曲缬沙坦对肾功能的长期影响及对肾功能不全4~5期患者的影响仍有待进一步研究。Objective To evaluate the effect of sacubitril valsartan versus angiotensin converting enzyme inhibitor/angiotensin receptor blocker(ACEI/ARB)on renal function in patients with or without heart failure.Methods Chinese and English databases were searched by computer,including the Cochrane Library,Wanfang database,PubMed,CNKI,Embase,Clinical Trials and other major medical databases.The search period was from the establishment of the database to January 2024.For the included randomized controlled studies,Cochrane bias risk assessment tool was used to analyze and evaluate the literature quality,and Review Manager 5.4 systematic evaluation and analysis software was used to analyze the data,in which relative risk(RR)was used as the effect indicator.According to the different heterogeneity,fixed effect model or random effect model were used to combine the effect size.Results Finally,15 literatures meeting the requirements were included,with a total of 20155 patients included(10085 patients in the control group and 10070 patients in the experimental group).Compared with ACEI/ARB drugs,the incidence of renal function deterioration(RR=0.84,95%CI:0.73-0.97,P=0.02),end-stage renal disease(RR=0.53,95%CI:0.30-0.96,P=0.03),serum creatinine>2.0 mg/dL(RR=0.79,95%CI:0.68-0.91,P<0.01),and serum potassium>6.0 mmol/L(RR=0.80,95%CI:0.69-0.93,P<0.01)were lower in the sacubitril/valsartan group after treatment.However,the incidence of angioedema(RR=2.41,95%CI:1.23-4.71,P=0.01)was higher in the sacubitril/valsartan group after treatment.In addition,there were no significant differences between the two groups in the incidence of acute renal impairment,estimated glomerular filtration rate(eGFR)reduction of more than 25%or more than 50%,creatinine greater than 2.5 mg/dL or 3.0 mg/dL,and hyperkalemia(serum potassium>5.5 mmol/L)after treatment.Conclusion Sacubitril/valsartan has a good protective effect on kidney,which can more effectively reduce the risk of renal deterioration and may replace ACEI/ARB.However,due to the fact that the follow-

关 键 词：沙库巴曲缬沙坦 血管紧张素转换酶抑制剂 心力衰竭 肾功能 血管紧张素受体阻滞剂 META分析 

分 类 号：R541.6[医药卫生—心血管疾病]