螺内酯治疗原发性醛固酮增多症高血压的循证评价

Evidence-based evaluation of spironolactone in the treatment of primary aldosteronism hypertension

目的系统评价螺内酯在治疗PA的临床疗效,为临床用药提供循证药学方面的参考。方法计算机检索Medline、CBM、Embase、Pubmed、Cochrane library、万方数据库、CNKI、VIP,检索时间从建库至2022年1月1日。收集治疗PA药物中含螺内酯(观察组)对比非螺内酯药物(对照组)在治疗PA其收缩压、舒张压、血钾的变化。收集的指标包括:收缩压、舒张压、血钾。根据纳入和排除的标准,利用Endnote软件进行文献筛查,资料提取,并使用Revman5.4软件进行数据处理。结果最终纳入15项研究,共2249例患者,观察组和对照组的Meta分析结果显示:在降低PA患者收缩压方面[WMD=-25.53 mmHg,95%CI(-30.89,-20.16),P<0.00001]、舒张压方面[WMD=-13.84 mmHg,95%CI(-17.23,-10.45),P<0.00001],观察组与对照组差异具有统计学意义,在血钾变化方面[WMD=3.09,95%CI(2.33,3.86),P<0.00001],观察组与对照组差异具有统计学意义。结论螺内酯在治疗PA患者的疗效显著。

Objective To systematically evaluate the clinical efficacy of spironolactone in the treatment of primary aldosteronism hypertension(PA),so as and to provide evidence-based pharmaceutical reference for clinical drug use.Methods Medline,CBM,Embase,Pubmed,Cochrane Library,Wanfang Database,China Full Text Journal Database(CNKI),and China Science and Technology Journal Database(VIP)were searched by computer,the retrieval time was from the establishment of the database to January 1,2022.The changes of systolic blood pressure,diastolic blood pressure and blood potassium in the treatment of PA drugs containing spironolactone(observation group)compared without spironolactone(control group)were collected.The collected indicators included systolic blood pressure,diastolic blood pressure,and blood potassium.According to inclusion and exclusion criteria,literature screening and data extraction were performed by Endnote software,and data processing was performed by Revman5.4 software.Results A total of 2249 patients were included in 15 studies.Meta-analysis results of observation group and control group showed that:decreased systolic blood pressure[WMD=-25.53 mm Hg,95%CI(-30.89,-20.16),P<0.00001]and diastolic blood pressure[WMD=-13.84 mm Hg,95%CI(-17.23,-10.45),P<0.00001]of PA patients,there was statistical significance in the difference between the observation group and the control group,and there was statistical significance in the difference between the observation group and the control group in terms of blood potassium change[WMD=3.09,95%CI(2.33,3.86),P<0.00001].Conclusions Spironolactone has a significant therapeutic effect on PA patients.