SGLT2抑制剂治疗心力衰竭疗效的系统评价

The efficacy of SGLT2 inhibitors in the treatment of heart failure:a systematic review

目的系统评价SGLT2抑制剂治疗心力衰竭的疗效。方法利用计算机对中国知网数据库(CNKI)、万方数据资源库、维普期刊资源库、中国生物医学文献服务系统(CBM)、Pubmed、Cochrane Library、Embase等进行检索,对符合纳入、排除标准的SGLT2抑制剂治疗心力衰竭的随机对照试验(RCT)研究文献进行筛选,纳入文献8篇(英文5篇,中文3篇),共计病例数9264例。两人独立评估及数据提取后,用Jadad量表进行质量评价,使用RevMan5.3软件对提取的有效数据进行系统评价。结果疗效分析:因心力衰竭住院率[OR=0.68,95%CI(0.60,0.77),Z=6.02,P<0.00001]、全因死亡率[OR=0.85,95%CI(0.75,0.97),Z=2.51,P=0.01]、复合指标(因心力衰竭住院率或心血管死亡)[OR=0.77,95%CI(0.69,0.86),Z=4.84,P<0.00001]、左室射血分数[MD=2.26,95%CI(3.80,0.71),Z=2.86,P=0.004]。结论SGLT2抑制剂能明显降低心力衰竭患者全因死亡率,减少因心力衰竭住院风险及心血管死亡事件,改善左室射血分数数值,但本研究纳入的研究文献数量有限,各研究间样本总量差距较大,故需要更多的临床研究及真实数据来验证这一结果。

Objective To systematicly evaluate SGLT2 inhibitors in the treatment of heart failure.Methods A systematic search on randomized controlled trial data in CNKI,Wanfang databases,Weipu journal resources databases,CBM,Pubmed,Cochrane Library,Embase,was performed.Two reviewers extracted data independently,and used Reviewer Manager Software(RevMan5.3)for statistical analysis.Results Eight studies(5 English papers,3 Chinese papers)with 9264 patients were included in the systematic review.Clinical efficacy analysis showed that hospitalization rate for heart failure[OR=0.68,95%CI(0.60-0.77),Z=6.02,P<0.00001];all-cause mortality[OR=0.85,95%CI(0.75-0.97),Z=2.51,P=0.01];Composite index(hospitalization rate for heart failure or cardiovascular mortality)[OR=0.77,95%CI(0.69-0.86),Z=4.84,P<0.00001];left ventricular ejection fraction[MD=2.26,95%CI(3.80,0.71),Z=2.86,P=0.004].Conclusion SGLT2 inhibitors can significantly reduce the all-cause mortality of patients with heart failure,reduce the hospitalization risk and cardiovascular death events due to heart failure,and improve left ventricular ejection fraction.However,the number of included research literature is limited,and the total sample size of each study is large.Therefore,more clinical studies and real world data are needed to verify this result.