沙库巴曲缬沙坦治疗射血分数保留的心力衰竭安全性的Meta分析  

A Meta-analysis of the safety of Sacubitril/Valsartan in the treatment of heart failure with preserved ejection fraction

作　　者：刘清清 王苏苹 王林江 袁媛[1] 周振宇[1] LIU Qingqing;WANG Suping;WANG Lingjiang;YUAN Yuan;ZHOU Zhenyu(Department of Cardiovascular the Second Clinical Medical College of North Sichuan Medical College,North 637000,China)

机构地区：[1]川北医学院第二临床医学院心血管内科,637000

出　　处：《心肺血管病杂志》2025年第2期191-199,共9页Journal of Cardiovascular and Pulmonary Diseases

基　　金：国家自然科学基金项目(82370449)。

摘　　要：目的:探索沙库巴曲缬沙坦治疗射血分数保留的心力衰竭的安全性。方法:检索PubMed、Web of Science、Embase等数据库自建库至2024年4月,沙库巴曲缬沙坦治疗射血分数保留的心力衰竭的随机对照试验。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险,采用RevMan5.3软件进行Meta分析。结果:与缬沙坦/依那普利/安慰剂相比,沙库巴曲缬沙坦可显著改善HFpEF患者的心力衰竭住院(RR=0.90,95%CI:0.84~0.96,P=0.001)和心力衰竭急性发作(RR=0.70,95%CI:0.53~0.94,P=0.02)的结果,发生肾损伤(RR=0.61,95%CI:0.41~0.92,P=0.02)、使肾小球滤过率下降>50%(RR=0.61,95%CI:0.41~0.92,P=0.02)和至少一次不良事件(RR=0.69,95%CI:0.48~0.97,P=0.03)的风险更低,但发生低血压(RR=1.58,95%CI:1.12~2.23,P=0.009)和血管性水肿(RR=2.22,95%CI:1.01~4.87,P=0.05)的风险更高。结论:沙库巴曲缬沙坦用于治疗射血分数保留的心力衰竭时,可更有效的减少心力衰竭住院及急性心力衰竭发作,且可减少肾损伤及不良事件的发生,但更易导致低血压及血管性水肿。Objective:To explore the safety of sacubitril/valsartan in the treatment of HFpEF.Methods:Computer retrieval of PubMed,Web of Science,Embase et al.was performed to collect randomized controlled trials of sacubitril/valsartan in the treatment of HFpEF fraction from the establishment of the databases until April,2024.Two researchers independently screened the literature,extracted data,and evaluated the risk of bias for inclusion in the study.Meta-analysis was performed using RevMan 5.3 software.Results:In individuals with HFpEF,compared to valsartan/enalapril/placebo,sacubitril/valsartan significantly improved outcomes due to hospitalization for heart failure(RR=0.90,95%CI:0.84-0.96,P=0.001)and acute heart failure(RR=0.70,95%CI:0.53-0.94,P=0.02).Compared with valsartan/enalapril/placebo,patients using sacubitril/valsartan had a lower risk of developing renal function damage(RR=0.61,95%CI:0.41-0.92,P=0.02),a>50%decrease in eGFR(RR=0.61,95%CI:0.41-0.92,P=0.02),and at least one adverse event(RR=0.69,95%CI:0.48-0.97,P=0.03).However,there was a higher risk of developing hypotension(RR=1.58,95%CI:1.12-2.23,P=0.009)and vascular edema(RR=2.22,95%CI:1.01-4.87,P=0.05).Conclusions:When used to treat HFpEF,sacubitril/valsartan can more effectively reduce hospitalization for heart failure,acute heart failure,renal function damage and adverse events compared to valsartan/enalapril/placebo.However,it is more likely to lead to hypotension and vascular edema.

关 键 词：射血分数保留的心力衰竭 沙库巴曲缬沙坦 不良事件 随机对照实验 荟萃分析 

分 类 号：R54[医药卫生—心血管疾病]