血管紧张素转换酶抑制剂/血管紧张素Ⅱ受体拮抗剂预防房颤发生的Meta分析

Angiotensin-converting enzyme inhibitor or angiotensin Ⅱ receptor blockers for preventing atrial fibrillation:a Meta-analysis

目的：评价血管紧张素转换酶抑制剂（ACEI）/血管紧张素Ⅱ受体拮抗剂（ARB）预防房颤发生/复发的效果。方法：计算机检索PubMed、ScienceDirect、Embase、Ovid、Cochrane图书馆临床对照试验资料数据库、中国生物医学文献数据库（2001年1月-2011年4月）中比较ACEI或ARB类药与其它药治疗心血管疾病的随机对照临床研究,按照入选与排除标准筛查文献,提取相关资料,采用Review Manager 4.2.9对所提取数据进行Meta分析。结果：共纳入14项随机对照研究,均为英文,研究病例数总计40 217例,其中治疗组20 260例,对照组19 957例。Meta分析表明,ACEI或ARB与其它药相比可预防房颤发生,其差异有统计学意义[OR=0.69,95%CI（0.63~0.75）,P〈0.000 1]。对不同基础疾病的亚组分析显示,高血压患者中服用ACEI/ARB较其他降压药在预防房颤发生方面差异有统计学意义[OR=0.69,95%CI（0.61~0.78）,P〈0.000 1];慢性心衰患者服用ACEI/ARB较其他常规治疗药可预防房颤发生[OR=0.61,95%CI（0.53~0.71）,P〈0.000 1];房颤患者中服用ACEI/ARB较其抗心律失常药可显著降低房颤复发率[OR=0.82,95%CI（0.69~0.98）,P=0.03]。结论：在高血压、慢性心衰及房颤患者,服用ACEI/ARB类药可降低房颤发生/复发率。

Objective： To evaluate the effects of angiotensin-converting enzyme inhibitors/angiotensin Ⅱreceptor antagonist on prevention of atrial fibrillation.Methods： RCTs were identified（Jan 2001-Apr 2011） by multiple data-base electronic search（MEDLINE via ScienceDirect,Embase,OVID,Cochrane Central Register of Controlled trials） and hand search of references,reviews and scientific society proceedings.Two investigators independently assessed trial inclusion and data extraction into standardised forms,differences resolved by consensus.Results：14 randomized controlled trials that enrolled 40 217 cases met the inclusion criteria.A total of 20 260 cases received ACEI or ARB,19 957 cases received other drugs.The Meta-analysis showed significant differents in prevention of atrial fibrillation in the treatment group [OR=0.69,95%CI（0.63~0.75）,P0.000 1].Conclusion： Angiotensin-converting enzyme inhibitors/angiotensin Ⅱ receptor antagonist have an effect on decreasing the incidence of atrial fibrillation.