醛固酮受体拮抗剂对轻-中度心衰患者有效性及安全性的Meta分析

Meta-analysis on efficiency and safety of aldosterone receptor antagonist in patients with mild to moderate heart failure

目的评价醛固酮受体拮抗剂(ARA)对轻-中度心衰的有效性及安全性。方法通过计算机检索Pub Med、Cochrane library、EMBase、万方数据库、中国生物医学文献数据库、维普中文数据库、中国期刊全文数据库,时间从建库至2014年3月前发表的关于ARA在NYHAⅠ-Ⅱ级患者中的应用的随机对照试验研究,使用Rev Man5.2统计软件进行Meta分析。结果共纳入7篇文献,Meta分析结果显示:使用ARA能降低心衰再住院率(OR=0.64,95%CI:0.54~0.76,P<0.01)、左室收缩末容积指数(SWD=-12.20 m L/m2,95%CI:-20.91^-3.45,P<0.01)、左室舒张末容积指数(SWD=18.91 m L/m2,-17.73^-0.10,P<0.05)及左室质量指数(SWD=10.95 g/m2,-15.49^-6.41,P<0.01),增加左室射血分数(SWD=4.69%,2.43~6.94,P<0.01),而副作用未见明显增加(男性乳房发育:OR=1.41,95%CI:0.71~2.82,P=0.33;高钾血症:OR=1.52,95%CI:0.98~2.36,P=0.06)。结论 ARA能逆转左室重构、提高心功能,降低轻中度心衰患者的心衰再住院率,而不明显增加副作用风险,临床上应提倡使用。

Objective To evaluate the efficiency and safety of aldosterone receptor antagonist( ARA) in patients with mild to mod-erate heart failure( HF) . Methods The following databases were searched, including PubMed, Cochrane library, EMBase, Wanfang data-base, CBMdisc, VIP database and CNKI from creation of database to March 2014 for randomized controlled trials ( RCTs) assessing the effects of ARA therapy in HF patients with NYHA classⅠ-Ⅱ, and a RevMan 5. 2 sotfware was used to analyze these data. Results Seven related papers were included. The result of Meta-analysis showed that using ARA reduced the readmission rate induced by HF(OR=0. 64, 95% CI:0. 54~0. 76, P<0. 01). And it also reduced left ventricular end-systolic volume index( LVESVI, SWD= -12. 20 mL/m2, 95% CI: -20. 91 ~ -3. 45, P <0. 01), left ventricular end -diastolic volume index( LVEDVI, SWD =18. 91 mL/m2, -17. 73 ^-0. 10, P<0. 05) and left ventricular mass index( LVMI, SWD=10. 95 g/m2, -15. 49~ -6. 41, P<0. 01), increased left ventricular ejection fraction(LVEF, SWD=4. 69%, 2. 43~6. 94, P<0. 01), and the side effects were not significantly increased( gynecomastia:OR=1. 41, 95% CI:0. 71~2. 82, P=0. 33;hyperkalemia:OR=1. 52, 95%CI:0. 98~2. 36,P=0. 06). Conclusion ARA can reverse left ventricular remodeling, improve the heart function and reduce the re-hospitalization rate induced by mild to moderate HF, and it doesn 't increase significantly the risk of producing the side effects. Hence, it should be advocated and applied in clinical practice.