沙库巴曲缬沙坦对射血分数保留心力衰竭影响的Meta分析

Influence of sacubitril-valsartan on heart failure with preserved ejection fraction:meta-analysis

目的:系统评价沙库巴曲缬沙坦治疗射血分数保留心力衰竭(HFpEF)的有效性与安全性。方法:运用万方、中国知网、中国生物医学文献服务系统、PubMed、EMBASE、WebofScience等数据库检索自启动期至2022年1月15日期间沙库巴曲缬沙坦用于HFpEF患者的随机对照试验。结果:共有13项研究8754名参与者符合纳入标准。本研究结果显示,与对照组相比,沙库巴曲缬沙坦可降低HFpEF患者的心衰再住院率[OR=0.76,95%CI(0.67,0.85),P=0.000],改善NYHA心功能分级[OR=1.85,95%CI(1.32,2.59),P=0.001],降低治疗后N末端脑钠肽前体(NT-proBNP)水平[SMD=-3.20,95%CI(-4.25,-2.14),P=0.001],增加患者6min步行试验(6MWT)的步行距离[WMD=57.51,95%CI(21.51,93.52),P=0.002];但在心血管死亡率、不良反应发生率、生活质量评分及左心房大小方面无显著差异(P均>0.05)。结论:沙库巴曲缬沙坦可以显著改善HFpEF患者的NT-proBNP、6MWD、NYHA心功能分级、心衰再住院率,而在心血管死亡率、不良反应发生率、生活质量评分及左心房大小方面无显著优势。

Objective:To systematically evaluate the effectiveness and safety of sacubitril-valsartan in the treatment of heart failure with preserved ejection fraction(HFpEF).Methods:Randomized controlled trials of sacubitril-valsartan in HFpEF patients from initiation to Jan 15,2022 were searched in Wanfang,CNKI,China Biomedical Literature Service,PubMed,Embase,and Web of Science databases.Results:A total of 8754 participants from 13 studies met the inclusion criteria.Results of the present study indicated that compared with control group,sacubitril-valsartan could reduce heart failure-caused rehospitalization rate[OR=0.76,95%CI(0.67,0.85),P=0.001],improve NYHA cardiac function class[OR=1.85,95%CI(1.32,2.59),P=0.001],reduce level of NT-proBNP after treatment[SMD=-3.20,95%CI(-4.25,-2.14),P=0.001]and improve the walking distance of 6 MWT[WMD=57.51,95%CI(21.51,93.52),P=0.002].However,there were no significant difference in cardiovascular mortality,incidence rate of adverse reactions,quality of life score,and left atrium size,P>0.05 all.Conclusion:Sacubitril-valsartan can significantly improve NT-proBNP,6 MWD,NYHA class and heart failure-caused rehospitalization rate in HFpEF patients,while there are no significant advantages in cardiovascular mortality,incidence rate of adverse reactions,quality of life score,and left atrium size.