沙库巴曲/缬沙坦治疗中国心力衰竭患者临床效果的meta分析

Meta-analysis of clinical effect of Sacubitril/Valsartan in the treatment of Chinese patients with heart failure

目的系统评价沙库巴曲/缬沙坦治疗中国心力衰竭患者的临床效果。方法计算机检索从建库至2022年5月Embase、PubMed、中国知网、万方数据库、维普数据库的沙库巴曲/缬沙坦治疗中国心力衰竭患者的所有真实世界研究。根据纳入及排除标准筛选文献并提取数据,采用非随机干预性研究偏倚评估工具评估偏倚风险,采用RevMan 5.4软件进行meta分析。结果共纳入9项观察性研究,总样本15461例。与对照组血管紧张素转换酶抑制剂/血管紧张素Ⅱ受体拮抗剂(ACEI/ARB)相比,研究组沙库巴曲/缬沙坦可以降低心力衰竭患者的心血管死亡风险(OR=0.54,95%CI:0.43~0.67,P<0.01)、全因死亡风险(OR=0.54,95%CI:0.33~0.87,P=0.01)、心血管死亡或心力衰竭住院的复合终点风险(OR=0.58,95%CI:0.51~0.65,P<0.01),心力衰竭住院风险的差异无统计学意义(OR=0.80,95%CI:0.58~1.09,P=0.16)。全因死亡和心力衰竭住院风险的异质性较高,主要与一项基于心力衰竭合并晚期肾脏病患者的研究有关。结论在中国射血分数降低心力衰竭的真实世界研究中,沙库巴曲/缬沙坦降低临床事件风险的效果优于ACEI/ARB类药物。

Objective To systematically evaluate the clinical effect of Sacubitril/Valsartan in the treatment of Chinese patients with heart failure.Methods A computer search was conducted for all real-world studies on the treatment of heart failure in China with Sacubitril/Valsartan in PubMed,Embase,CNKI,Wanfang,VIP database from self-built database to May 2022.Literature was screened according to inclusion and exclusion criteria and data was extracted.The risk of bias in non-randomized studies of interventions assessment tool was used to evaluated the risk of bias and RevMan 5.4 software was used for meta-analysis.Results Nine observational studies with a total of 15461 patients were included.Compared to angiotensin converting enzyme inhibitors/angiotensin receptor blockers(ACEI/ARB)in the control group,Sacubitril/Valsartan was associated with a significant reduction in cardiovascular mortality(OR=0.54,95%CI:0.43-0.67,P<0.01),all-cause mortality(OR=0.54,95%CI:0.33-0.87,P=0.01)and the composite endpoint of cardiovascular mortality or hospitalization for heart failure(OR=0.58,95%CI:0.51-0.65,P<0.01)of patients with heart failure in experimental group.There was no significant difference in the risk of hospitalization for heart failure(OR=0.80,95%CI:0.58-1.09,P=0.16).Heterogeneity of all-cause mortality or hospitalization for heart failure was high and mainly related to the study of patients with heart failure and advanced kidney disease.Conclusion In the real-world studies of heart failure with reduced ejection fraction in China,Sacubitril/Valsartan was superior to ACEI/ARB in reducing the risk of clinical events.