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摘要: 目的:达格列净属于钠-葡萄糖协同转运蛋白2(SGLT-2)抑制剂。本研究评价达格列净治疗心力衰竭的疗效和安全性。方法:根据协同检索策略,检索Medline、Embase、中文万方数据库、CNKI、Cochrane图书馆临床对照试验资料库。仅纳入所有关于达格列净治疗心力衰竭的随机对照试验(RCT)。由2名评价员独立对纳入的文献进行质量评价和数据提取。采用风险比(hazard ratio,HR)和相对危险度(relative risk,RR)及其95%置信区间(CI)评价达格列净治疗心力衰竭的疗效和安全性。采用Stata 11.0软件进行Meta分析。结果:纳入5项随机对照试验,共计5998例患者。Meta分析结果显示达格列净联合常规治疗与安慰剂联合常规治疗比较,有效降低心血管死亡/心力衰竭住院复合终点事件(HR=0.73,95%CI 0.64~0.83,P<0.001),降低心血管死亡风险(RR=0.80,95%CI 0.68~0.93,P=0.005),降低心力衰竭住院风险(HR=0.68,95%CI 0.58~0.80,P<0.001),降低全因死亡风险(RR=0.80,95%CI 0.70~0.92,P=0.002)。达格列净不增加严重低血糖、容量不足、肾脏不良事件和截肢等风险。结论:达格列净可以降低心力衰竭患者的死亡和心力衰竭住院风险。Abstract: Objective: Dapagliflozin is an inhibitor of sodium-dependent glucose transporters 2. This meta-analysis aimed to evaluate efficacy and safety of dapagliflozin for heart failure.Methods: According to the collaborative search strategy, MEDLINE, Embase, Chinese Wanfang database, CNKI, the clinical control test database of Cochrane Library and were searched. Only randomized controlled trials(RCT) were included in this research. Quality assessment and data extraction were conducted by two independent investigators. The hazard ratio(HR) and relative risk(RR) with 95% confidence intervals(CI) were used to assess efficacy and safety of dapagliflozin for heart failure. Meta-analysis was conducted by Stata 11.0.Results: The 5 RCTs were included in the meta-analysis involving 5998 patients. Compared with placebo combined with standard therapy, dapagliflozin combined with standard therapy was associated with a lower risk of cardiovascular mortality/hospitalization for heart failure composite events(HR=0.73, 95%CI 0.64~0.83, P<0.001), cardiovascular mortality(RR=0.80, 95%CI 0.68~0.93, P=0.005), hospitalization for heart failure(HR=0.68, 95%CI 0.58~0.80, P<0.001), and all-cause mortality(RR=0.80, 95%CI 0.70~0.92, P=0.002). Dapagliflozin didn't increase the risk of major hypoglycemia, volume depletion, renal adverse event and amputation.Conclusion: Dapagliflozin could lower the risk of mortality and hospitalization for heart failure effectively.
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Key words:
- dapagliflozin /
- heart failure /
- randomized controlled trial /
- meta-analysis
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