沙库巴曲缬沙坦钠联合左西孟旦治疗射血分数降低型心力衰竭有效性和安全性的Meta分析

A Meta-analysis of the efficacy and safety of Sacubitril/Valsartan combined with levosimendan in the treatment of heart failure with reduced ejection fraction

目的:系统评价沙库巴曲缬沙坦钠联合左西孟旦治疗射血分数降低型心力衰竭(heart failure with reduced ejection fraction,HFrEF)的有效性与安全性。方法:计算机检索PubMed、The Cochrane Library、Embase、Web of science、中国生物医学文献服务系统、中国学术期刊全文数据库、维普中文科技期刊数据库和万方数据库。搜索沙库巴曲缬沙坦钠联合左西孟旦治疗HFrEF的相关随机对照试验,检索时限为建库至2023年12月。由两位研究者独自筛选文献、提取相关有效信息和纳入评价研究的偏移风险后,使用RevMan5.4.1分析工具进行Meta分析。结果:纳入12个研究,共计1234例患者。Meta分析结果显示:沙库巴曲缬沙坦钠联合左西孟旦组的NYHA心功能改善总有效率高于对照组(RR=4.46,95%CI:2.86~6.94,P<0.00001),LVEF高于对照组(MD=6.09,95%CI:5.57,6.60,P<0.00001),LVEDD低于对照组(MD=-3.90,95%CI:-4,75~3.06,P<0.00001),不良反应低于对照组(RR=0.39,95%CI:0.21~0.72,P=0.0.003)。结论:当前证据显示,沙库巴曲缬沙坦钠联合左西孟旦能改善NYHA心功能分级,提高射血分数及抑制心室重构,而未出现明显不良反应。

Objective:To systematically review the efficacy and safety of Sacubitril/Valsartan combined with levosimendan in treating heart failure with reduced ejection fraction.Methods:A computerized search was conducted across PubMed,The Cochrane Library,Embase,Web of Science,CBM,CNKI,VIP,and Wanfang databases for randomized controlled trials(RCTs)on the treatment of HFrEF with Sacubitril/Valsartan combined with levosimendan,up to December 2023.Two researchers independently screened the literature,extracted relevant data,and assessed the risk of bias before conducting a Meta-analysis using RevMan 5.4.1.Results:Twelve studies involving 1234 patients were included.The Meta-analysis revealed that the combination therapy group showed a significantly higher overall efficacy in improving NYHA functional class compared to the control group(RR=4.46,95%CI:2.86-6.94,P<0.00001),with a greater increase in left ventricular ejection fraction(MD=6.09,95%CI:5.57-6.60,P<0.00001)and a more significant reduction in left ventricular end-diastolic diameter(MD=-3.90,95%CI:-4,75-3.06,P<0.00001).The incidence of adverse reactions was lower in the combination therapy group(RR=0.39,95%CI:0.21-0.72,P=0.0.003).Conclusions:Current evidence suggests that the combination of Sacubitril/Valsartan and levosimendan can improve NYHA functional class,increase ejection fraction,and inhibit ventricular remodeling without significant adverse reactions.