LCZ696治疗心力衰竭有效性与安全性meta分析

目的 通过检索国内外有关LCZ696（沙库巴曲缬沙坦钠）治疗心力衰竭的RCTs，评价LCZ696治疗心力衰竭的有效性与安全性。方法 通过Cochrane library、Pubmed、Web of science、CNKI、VIP、万方数据库检索有关LCZ696治疗心力衰竭的文献，根据纳入排除标准进行文献筛选，采用Cochrane干预措施系统评价手册5.1.0版中的偏倚风险评估工具对纳入研究进行质量评价，所有结局指标均使用RevMan 5.3软件进行meta分析。结果 共选入6篇RCTs研究，共计14 967例患者被纳入，合并结局指标结果显示，与依那普利和缬沙坦比较，LCZ696治疗后左心室容积指数（LAVI）［WMD=-2.18，95%CI（-3.63，-0.74），P=0.003］、舒张早期二尖瓣最大充盈速度与舒张早期二尖瓣环最大速度比值（E/e'）［WMD=-1.01，95%CI（-1.89，-0.12），P=0.03］、病死率［RR=0.89，95%CI（0.83，0.96），P=0.003］、因心力衰竭再住院率［RR=0.83，95%CI（0.78，0.88），P<0.01］下降更明显，而生活质量评分［WMD=1.32，95%CI（0.69，1.95），P<0.01］、症状性低血压发生率［RR=1.46，95%CI（1.34，1.60），P<0.01］升高更为明显。结论 LCZ696可以明显降低心力衰竭患者的病死率和再住院率，且不增加肾功能损伤、血管性水肿、高血钾不良事件风险。

Meta analysis of efficacy and safety of LCZ696 in treatment of heart failure

Objective To evaluate the efficacy and safety of LCZ696 in the treatment of heart failure by searching its RCTs at home and abroad.Methods The Cochrane library, Pubmed, Web of science, CNKI, VIP, Wanfang database were searched for literatures on LCZ696 for heart failure. And the literature were screened according to the inclusion and exclusion criteria.The bias risk assessment tool in Cochrane intervention system evaluation manual version 5.1.0 was used to evaluate the quality of included studies, and RevMan 5.3 software was used to conduct the meta analysis of all outcome indexes.Results A total of 14 967 patients were enrolled in 6 RCTs studies. Combined outcome indicators showed that LCZ696, LAVI ( WMD=-2.18, 95%CI［-3.63, -0.74］, P=0.003), E/e' (WMD=-1.01, 95%CI［-1.89, -0.12］, P=0.03), mortality (RR=0.89, 95%CI［0.83, 0.96］, P=0.003), the rate of re hospitalization for heart failure (RR=0.83, 95%CI［0.78, 0.88］, P<0.01) decreased more significantly after the treatment, while the quality of life score (WMD=1.32, 95%CI［0.69, 1.95］, P<0.01) and the incidence of symptomatic hypotension　(RR=1.46, 95%CI［1.34, 1.60］, P<0.01) increased more significantly.ConclusionLCZ696 can significantly reduce the mortality and re hospitalization rate of patients with heart failure, and it does not increase the risk of adverse events such as renal injury, angioedema and hyperkalemia.