ACEI类药物降低高血压患者充血性心力衰竭风险的Meta分析

Meta-analysis of ACEIs for prevention of congestive heart failure

目的评价血管紧张素转换酶抑制剂(ACEIs)是否能降低充血性心力衰竭(CHF)的发生风险。方法通过计算机检索CENTRAL(the Cochrane central register of controlledtrials)、EMBASE、Medline、万方数据库、中国期刊全文数据库(CNKI)、中国生物医学文献数据库系统(CBM)等,收集公开发表的涉及ACEI类药物预防CHF作用的随机对照研究(RCT)。研究人群为高血压高危人群;干预措施为口服ACEI类药物;对照组为安慰剂;结局指标为充血性心力衰竭发生率,并以相对危险度(relative risk,RR)及相应的95%可信区间(95%confidence interval,95%CI)为效应指标对结局进行比较。I2检验来检测各研究间的统计学异质性。双侧P<0.05认为各研究间存在明显的异质性。采用Egger法对发表偏倚进行量化检测。应用统计软件ReviewMan 5.0和Stata 11.0进行数据分析。结果纳入分析的文章有5篇,共31750例受试者,其中ACEIs组15894例,对照组15856例。ACEIs组共发生CHF 336例,发生率为2.1%;对照组共发生CHF 442例,发生率为2.7%。Meta分析结果显示,ACEI组受试者随访期间发生CHF的风险是安慰剂组的67%(RR=0.67,95%CI:0.66～0.87,P<0.001)。结论 ACEIs可以显著降低高血压高危人群CHF的发生风险。

Objective To evaluate the effect of the angiotensin-converting enzyme inhibitors（ACEIs） on preventing congestive heart failure（CHF） in high risk of hypertension subjects.Methods By searching CENTRAL（the Cochrane central register of controlledtrials）,Medline,EMBSE,CBM,CNKI and WANFANG et al,we collected published randomized controled trials（RCTs）or cohort studies about the the effect of the angiotensin-converting enzyme inhibitors（ACEIs） on preventing congestive heart failure（CHF） in high risk of hypertension subjects.The study subjects were people with high rik of hypertension;the intervention was ACEIs;the control was placebo;and the outcome was the incidence of CHF,measured by relativ risk（RR） and its 95% confidence interval（CI）.The statistical heterogeneity was tested by cochran＇s chi-square test（Q test）.The Egger test was used to test the publication bias.The data was analysised by using statistic software.Review Man 5.0 and Stata11.0.Results 5 trials that included a total of 31750 subjects were analyzed in the meta-analysi.15894 were in the ACEIs group and 15856 were in the placebo group.The pooled relatie risk（RR）for preventing CHF was 0.67（RR=0.67,95%CI：0.66~0.87 P0.001） in the ACEIs group compared with the control group.Conclusion The ACEIs can significent decrease the risk of CHF in the subject with high risk of hypertension.