氯沙坦对比其他血管紧张素受体拮抗剂对血尿酸水平影响的Meta分析

Effect of Losartan compared with other ARBs on serum uric acid level:a Meta-analysis and systematical review

目的系统评价氯沙坦对比其他血管紧张素受体拮抗剂(ARB)对高血压患者血尿酸水平的影响,为临床有降尿酸需求的高血压患者用药决策提供循证证据。方法检索PubMed、Embase、Cochrane Library、中国知网(CNKI)、万方、维普等数据库,纳入符合标准的随机对照研究(RCT)及队列研究。评价纳入研究质量并根据设计的Excel表格提取数据,以加权均数差(WMD)为效应量,使用RevMan5.4版、Stata 15版软件进行Meta分析,GRADEpro GDT网站进行证据质量评价。结果共纳入24篇文献,其中13项RCT,11项队列研究。结果显示,氯沙坦对比其他ARB能有效降低血尿酸水平,优于替米沙坦(WMD=-81.54,95%CI:-108.71~-54.38),缬沙坦(WMD=-92.19,95%CI:-125.49~-58.89),坎地沙坦酯(WMD=-27.34,95%CI:-35.92~-18.76)及厄贝沙坦(WMD=-91.82,95%CI:-148.00~-35.64);与奥美沙坦和依普沙坦(WMD=-12.62,95%CI:-32.54~7.30)相比差异无统计学意义。结论当前证据显示,在ARB类降压药中,氯沙坦具有显著降低血尿酸水平的优势,且这一优势与目标人群是否合并高尿酸血症、氯沙坦剂量和用药时长无明显相关。

Objective Systematically review the effects of losartan compared with other angiotensin receptor antagonists(ARB)on blood uric acid levels in patients with hypertension,so as to provide evidence-based evidence for the medication decisions of patients with clinical hypertension and hyperuricemia.Method PubMed,Embase,Cochrane Library,CNKI,Wanfang,VIP and other databases were searched,and randomized controlled studies(RCT)and cohort studies that met the inclusion and exclusion criteria were enroued.The quality of the included studies was evaluated,and the data was extracted according to the designed Excel table.The weighted mean difference(WMD)was used as the effect size,and the RevMan 5.4 and Stata 15 softwares were used for meta-analysis.The GRADEpro GDT website was used to evaluate the quality of evidence.Result A total of 24 studies were included,including 13 RCTs and 11 cohort studies.The results showed that compared with other ARBs,Losartan can effectively reduce blood uric acid levels,which is better than Telmisartan(WMD=-81.54,95%CI:-108.71 to-54.38),Valsartan(WMD=-92.19,95%CI:-125.49 to-58.89),Candesartan(WMD=-27.34,95%CI:-35.92to-18.76)and Irbesartan(WMD=-91.82,95%CI:-148.00 to-35.64);there was no significant difference compared with Olmesartan and Eprosartan(WMD=-12.62,95%CI:-32.54 to 7.30).Conclusion Current evidence shows that among the ARB antihypertensive drugs,losartan has the advantage of significantly lowering blood uric acid levels,and long-term medication has similar uric acid-lowering effects to valsartan.