培哚普利治疗充血性心力衰竭的meta分析

A meta-analysis of the efficacy and safety of perindopril in the treatment of congestive heart failure

目的:比较培哚普利与血管紧张素Ⅱ受体拮抗剂治疗充血性心力衰竭的有效性和安全性。方法:系统检索Pubmed、Embase、Cochrane library、Clinical trials.gov、中国学术期刊网络出版总库、中国生物医学文献服务系统,根据纳入和排除标准筛选文献、提取数据,并使用Rev Man5.3软件进行结果分析。结果:共纳入16项随机对照研究,包含1 169名患者。Meta分析结果显示,培哚普利与坎地沙坦相比,在心功能改善情况方面差异无统计学意义(RR=1.02,95%CI:0.86~1.12);培哚普利与缬沙坦、坎地沙坦相比,在增加左心室射血分数、降低左室重量指数、降低左室后壁厚度、降低左室舒张末径、降低收缩压和降低舒张压方面差异无统计学意义(P值均>0.05)。培哚普利与缬沙坦相比,在咳嗽事件的发生率方面差异无统计学意义(RR=7.48,95%CI:0.94~59.21)。结论:对于充血性心力衰竭,培哚普利的疗效和安全性与血管紧张素Ⅱ受体拮抗剂相似,但仍需高质量的临床研究来进一步验证。

Objective： To systematically review the efficacy and safety of perindopril versus angiotensin receptor blockers（ARB） in the treatment of congestive heart failure（CHF）. Methods： Randomized controlled trials（RCTs） that evaluated the comparative effects of perindopril versus ARB in patients with CHF were searched from the database Pubmed, Embase, Cochrane library, Clinical trials. gov, CAJD, and sinomed. Literature was screened and extracted according to the inclusion and exclusion criteria, and results were analyzed using Rev Man5.3 software. Results： 16 RCTs involving 1 169 patients were enrolled. Perindopril could improve cardiac function as the same as candesartan（n=160, RR=1.02, 95%CI： 0.86-1.12, P=0.82）. There was no statistical significant difference in left ventricular ejection fraction improvement, left ventricular mass index reduction, left ventricular posterior wall thickness reduction, left ventricle end-diastolic dimension reduction, SBP reduction, and diastolic pressure reduction between perindopril and valsartan and candesartan. There was no statistically significant difference in the incidence of cough between perindopril and valsartan（n=140, RR=7.48, 95% CI： 0.94-59.21, P=0.06）. Conclusion： The meta-analysis indicates that the cardiac function improvement and the incidence of adverse events of perindopril is as the same as ARBs（candesartan and valsartan）. Further clinical studies are required to verify the results.