达格列净联合沙库巴曲缬沙坦治疗急性心肌梗死后心力衰竭疗效及安全性的Meta分析

Efficacy and safety of dapagliflozin combined with sacubitril valsartan in the treatment of heart failure after acute myocardial infarction:a Meta-analysis

目的系统评价达格列净联合沙库巴曲缬沙坦治疗急性心肌梗死后心力衰竭的疗效及安全性。方法计算机检索PubMed、Embase、Web of Science、The Cochrane Library、CNKI、WanFang Data和VIP数据库,搜集关于达格列净联合沙库巴曲缬沙坦(联合治疗组)对比沙库巴曲缬沙坦(单一治疗组)治疗急性心肌梗死后心力衰竭的随机对照试验(RCT),检索时限均从建库至2024年6月18日。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.4软件进行Meta分析。结果共纳入11个RCT,累计1060例患者。Meta分析结果显示,与单一治疗组相比,联合治疗组患者临床有效率[OR=5.08,95%CI(2.81,9.16),P<0.001]、左室射血分数[MD=5.02,95%CI(4.08,5.95),P<0.001]、6 min步行距离[MD=56.45,95%CI(32.83,80.07),P<0.001]均显著提高,N末端脑钠肽前体水平[MD=-249.28,95%CI(-414.78,-83.78),P=0.003]、主要心血管不良事件发生率[OR=0.24,95%CI(0.15,0.41),P<0.001]均显著降低,而两组患者的药品不良反应发生率差异无统计学意义[OR=0.66,95%CI(0.31,1.38),P=0.27]。结论当前证据显示,急性心肌梗死后心力衰竭使用达格列净和沙库巴曲缬沙坦联合治疗与单一使用沙库巴曲缬沙坦治疗相比,临床效果更优,且不会增加药品不良反应发生率。受纳入研究数量和质量的限制,上述结论尚待更多高质量研究予以验证。

Objective To systematically review the efficacy and safety of dapagliflozin combined with sacubitril valsartan in the treatment of heart failure after acute myocardial infarction.Methods PubMed,Embase,Web of Science,Cochrane Library,CNKI,WanFang Data and VIP databases were electronically searched to collect randomized controlled trials(RCTs)on dapagliflozin combined with sacubitril valsartan(combination treatment group)vs.sacubitril valsartan(monotherapy group)for the treatment of heart failure after acute myocardial infarction from inception to June 18,2024.Two reviewers independently screened the literature,extracted data and assessed the risk of bias of the included studies.Meta-analysis was performed using RevMan 5.4 software.Results A total of 11 RCTs involving 1060 patients were included.Meta-analysis results showed that compared with the monotherapy group,the efficiency of clinical treatment(OR=5.08,95%CI 2.81 to 9.16,P<0.001),left ventricular ejection fraction(MD=5.02,95%CI 4.08 to 5.95,P<0.001),6-minute walking distance(MD=56.45,95%CI 32.83 to 80.07,P<0.001)significantly increased in the combination treatment group,and the levels of N-terminal brain natriuretic peptide precursor(MD=-249.28,95%CI-414.78 to-83.78,P=0.003)and the incidence of major adverse cardiovascular events(OR=0.24,95%CI 0.15 to 0.41,P<0.001)significantly decreased in the combination treatment group.However,there was no statistically significant difference between the two groups in terms of reducing the incidence of adverse effects(OR=0.66,95%CI 0.31 to 1.38,P=0.27).Conclusion Current evidence shows that the use of the combination of dapagliflozin and sacubitril valsartan for heart failure after acute myocardial infarction is more effective clinically and does not increase the incidence of adverse drug reactions compared with the treatment of sacubitril valsartan alone.Due to the limited quality and quantity of the included studies,more high-quality studies are needed to verify the above conclusion.