沙库巴曲缬沙坦对急性心肌梗死后不良心血管事件及心功能影响的Meta分析

冯娟; 闫奎坡; 朱翠玲; 朱明军; 孙彦琴; 徐亚洲; 郭雨晴; 刘刚

doi:10.13201/j.issn.1001-1439.2021.06.008

沙库巴曲缬沙坦对急性心肌梗死后不良心血管事件及心功能影响的Meta分析

- 1. 河南中医药大学(郑州,450000);
- 2. 河南中医药大学第一附属医院心脏中心
基金项目:
国家自然科学基金青年基金支持项目(No:81303073)

河南省首批青苗人才(No:192102310161、182102310291)

河南省中医药科学研究专项课题(No:2017ZY2017)

河南省中医药科学研究专项课题(No:2016ZY3003、2016ZY2051、2017ZY2017)

河南省中医药科学研究专项(No:20-21ZY1015、20-21ZY2004)

详细信息

通讯作者: 闫奎坡,E-mail:ykp19821122@163.com

中图分类号: R542.2

收稿日期: 2020-12-07

修回日期: 2021-03-30

The effects of sacubitril/valsartan on adverse cardiovascular events and cardiac function after acute myocardial infarction:a Meta analysis

- 1. He'nan University of Chinese Medicine, Zhengzhou, 450000, China;
- 2. Heart Center,The First Affiliated Hospital of He'nan University of Chinese Medicine

More Information

Corresponding author: YAN Kuipo, E-mail: ykp19821122@163.com

Received Date: 07 December 2020

Revised Date: 30 March 2021

摘要

摘要: 目的:系统评价沙库巴曲缬沙坦对急性心肌梗死后不良心血管事件和心功能的影响。方法:全面检索PubMed、Cochrane Library、EMBase、中国知网、万方、维普、CBM等从建库至2021年1月发表的沙库巴曲缬沙坦治疗急性心肌梗死的随机对照试验。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RevMan5.3软件进行Meta分析。结果:纳入13篇文献,共1312例患者。Meta分析显示,急性心肌梗死患者在常规治疗的基础上加用沙库巴曲缬沙坦可进一步降低不良心血管事件总发生率[RR=0.54,95%CI:(0.40,0.72),P<0.000 1]和再住院率[RR=0.42,95%CI:(0.29,0.61),P<0.000 01];沙库巴曲缬沙坦组恶性心律失常发生率[RR=0.70,95%CI:(0.31,1.58),P=0.39]、再发心肌梗死发生率[RR=0.67,95%CI:(0.28,1.60),P=0.37]、再发心绞痛发生率[RR=0.55,95%CI:(0.21,1.41),P=0.21]和病死率[RR=0.49,95%CI:(0.21,1.15),P=0.10]与对照组相比较差异无统计学意义;沙库巴曲缬沙坦组较对照组进一步提高左室射血分数[MD=5.26,95%CI:(4.00,6.52),P<0.000 01],降低左室舒张期末内径[MD=-2.62,95%CI:(-3.31,-1.93),P<0.000 01],且不增加低血压[RR=0.69,95%CI:(0.26,1.83),P=0.45]、血管性水肿[RR=0.60,95%CI:(0.15,2.46),P=0.48]和高钾血症[RR=1.00,95%CI:(0.18,5.60),P=1.00]的发生率。结论:急性心肌梗死后应用沙库巴曲缬沙坦可有效改善患者心功能,降低不良心血管事件发生率、再住院率,且无明显的不良反应。
- 急性心肌梗死 /
- 沙库巴曲缬沙坦钠 /
- 心功能 /
- 不良心血管事件 /
- 病死率 /
- 再住院率 /
- 不良反应
Abstract: Objective: To evaluate the effects of sacubitril/valsartan on adverse cardiovascular events and cardiac function after acute myocardial infarction.Methods: We searched Pubmed, Cochrane Library, EMBase, CNKI, WanFang, VIP, CBM databases for the related randomized controlled trials from the establishment of the database to January 2021. Two reviewers screened literatures, extracted data and assessed the risk of bias of included studies. The Meta-analysis was performed by RevMan 5.3 software.Results: A total of 13 articles involving 1312 patients were included. Meta analysis showed that sacubitril/valsartan combined with conventional treatment further reduced the total incidence of adverse cardiovascular events[RR=0.54, 95%CI:(0.40, 0.72), P<0.000 1]and rehospitalization rate[RR=0.42, 95%CI:(0.29, 0.61), P<0.000 01]. There was no difference between the sacubitril/valsartan group and the control group in the incidence of malignant ventricular arrhythmia[RR=0.70, 95%CI:(0.31, 1.58), P=0.39], recurrent myocardial infarction[RR=0.67, 95%CI:(0.28, 1.60), P=0.37], recurrent angina pectoris[RR=0.55, 95%CI:(0.21, 1.41), P=0.21], and mortality[RR=0.49, 95%CI:(0.21, 1.15), P=0.10]. Compared with the control group, the sacubitril/valsartan group better increased left ventricular ejection fraction[MD=5.26, 95%CI:(4.00, 6.52), P<0.000 01], reduced left ventricular end diastolic diameter[MD=-2.62, 95%CI:(-3.31,-1.93), P<0.000 01], without increasing the incidence of adverse reactions such as hypotension[RR=0.69, 95%CI:(0.26, 1.83), P=0.45], angioedema[RR=0.60, 95%CI:(0.15, 2.46), P=0.48], and hyperkalemia[RR=1.00, 95%CI:(0.18, 5.60), P=1.00].Conclusion: Sacubitril/valsartan can effectively improve the cardiac function of patients with acute myocardial infarction, and reduce the incidence of adverse cardiovascular events, and rehospitalization rate without obvious adverse reactions.
- sacubitril/valsartan /
- acute myocardial infarction /
- cardiac function /
- adverse cardiovascular events /
- mortality /
- rehospitalization rate /
- adverse reactions

HTML全文

参考文献(19)

[1]	Sheng QH,Hsu CC,Li JP,et al.Combining fragmented QRS and TIMI score for predicting in-hospital short-term prognosis after acute myocardial infarction[J].J Zhejiang Univ Sci B,2018,19(5):349-353.
[2]	Ni YQ,Tang JJ,Tai S,et al.Risk factors for early death in acute myocardial infarction patients complicating with ventricular septal rupture[J].Zhonghua Xin Xue Guan Bing Za Zhi,2018,46(12):981-986.
[3]	Batra G,Lindhagen L,Andell P,et al.Angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers are associated with improved outcome but do not prevent new-onset atrial fibrillation after acute myocardial infarction[J].J Am Heart Assoc,2017,6(3):e005165.
[4]	McMurray JJ,Packer M,Desai AS,et al.Angiotensinneprilysin inhibition versus enalapril in heart failure[J].N Engl J Med,2014,371(11):993-1004.
[5]	王启东,赖木乔.沙库巴曲缬沙坦对急性ST段抬高型前壁心肌梗死并心力衰竭患者心功能的影响[J].广州医科大学学报,2019,47(1):92-95.
[6]	陈春望,钱文浩,丁浩,等.沙库巴曲缬沙坦对急性前壁心肌梗死急诊PCI术后合并心功能不全患者近期预后的影响[J].现代生物医学进展,2019,19(19):3720-3725.
[7]	王海燕,姜卫星,田丽,等.沙库巴曲缬沙坦对急性前壁ST段抬高型心肌梗死PCI术后心力衰竭患者心功能的影响[J].河北医科大学学报,2020,41(3):254-258+267.
[8]	杨红,孙晓妍,刘静,等.沙库巴曲缬沙坦对老年人急性心肌梗死后慢性心力衰竭发生的影响[J].中华老年医学杂志,2020,39(1):38-42.
[9]	陈会校,李娟,韩继如,等.沙库巴曲缬沙坦联合急诊PCI治疗急性心肌梗死合并心功能不全的疗效研究[J].中国循证心血管医学杂志,2020,12(6):690-693.
[10]	黄丽娟,曾玉玲,占德进,等.沙库巴曲缬沙坦钠对急性心肌梗死泵衰竭患者疗效及心功能、心室重构指标的影响[J].微循环学杂志,2020,30(3):36-40.
[11]	史忠良,甘建祥,郑亚国,等.沙库巴曲缬沙坦钠对急性心肌梗死后心功能不全患者的疗效[J].中国临床研究,2020,33(6):792-795.
[12]	简春燕,吴一帆,江金,等.沙库巴曲缬沙坦钠对直接PCI的急性心肌梗死患者心功能保护作用的临床研究[J].中国现代药物应用,2020,14(13):143-145.
[13]	李娟,陈会校,柴巧英,等.沙库巴曲缬沙坦对急性心肌梗死急诊冠脉介入术后心功能的影响[J].中国临床研究,2020,33(9):1200-1203.
[14]	东洋,杜秋红,杨蕾,等.沙库巴曲缬沙坦对急性ST段抬高型心肌梗死急诊经皮冠状动脉介入治疗术后合并心力衰竭患者治疗效果观察[J].临床军医杂志,2020,48(10):1248-1249+1252.
[15]	Haiyan Wang,Xianghua Fu.Effects of sacubitril/valsartan on ventricular remodeling in patents with left ventricular systolic dysfunction following acute anterior wall myocardial infarction[J].Coron Artery Dis,2020.
[16]	Yi Zhang,Yongbo Wu,Kai Zhang,et al.Benefits of early administration of Sacubitril/Valsartan in patients with ST-elevation myocardial infarction after primary percutaneous coronary intervention[J].Coron Artery Dis,2020.
[17]	赵玉君,董自平,路桂杰,等.沙库巴曲缬沙坦对急诊PCI术后心力衰竭患者心功能的影响[J].北方药学,2020,17(2):11-12.
[18]	盛兆雪,刘臣,周鹏,等.急性心肌梗死合并心源性休克患者临床特征和预后变化的单中心结果[J].中华医学杂志,2018,98(39):3208-3211.
[19]	刘岳,汪芳.沙库巴曲缬沙坦的药代动力学和药效学特点[J].中国循环杂志,2018,33(2):198-200.