ACEI联用ARB治疗慢性心力衰竭的疗效和安全性Meta分析

目的通过对慢性心力衰竭患者在接受相关治疗后的总体死亡率、住院情况、副反应进行比较,对血管紧张素转换酶抑制剂(ACEI)联用血管紧张素受体拮抗剂(ARB)治疗慢性心力衰竭的疗效和安全性进行评价。方法检索MEDLINE(1966-2008)、Cochrane图书馆(1980-2008)、中国生物医学文献数据库(1980-2008),万方数据库(1980-2008),纳入比较ACEI单用与ACEI和ARB合用治疗慢性心力衰竭的随机对照试验,对纳入研究的方法学进行评价,并应用RevMan5.0软件进行统计分析。结果共有7个随机对照研究入选,病例数总计5 853例,其中治疗组2 945例,对照组2 908例。Meta分析结果显示联合治疗组在全因死亡率和全因住院率方面与对照组相比无统计学意义。而在减少全因死亡与全因住院的联合终点事件、降低心衰住院事件、增加副反应方面有统计学意义,合并效应量分别为(RR:0.94;95%CI:0.90～0.98)、(RR:0.86;95%CI:0.79～0.93)、(RR:1.40;95%CI:1.24～1.58)。结论 ACEI基础上加用ARB与单用ACEI相比,可以使慢性心衰患者受益,但同时副反应的发生率有所增加。因此对于慢性心衰在ACEI基础上加用ARB应采取审慎的策略。合用则需要严密监测,防止副反应发生。

Efficacy and Safety of Angiotensin-coverting Enzyme Inhibitor Combined with Angiotensin Receptor Blocker for Treatment of Chronic Heart Failure:A Meta-analysis of Randomized Controlled Trials

Objective To evaluate the efficacy and safety of the combination of angiotensin-coverting enzyme inhibitor(ACEI)and angiotensin receptor blocker(ARB) versus ACEI alone on the deaths from any cause,the hospital admissions for any reason,the combined endpoint of deaths or hospitalization and adverse events in patients with chronic heart failure(CHF).Methods We searched MEDLINE(1966—2008),the Cochrane Library(1980—2008),the Chinese Biomedicine Database(1980—2008),and the Wanfang Database(1980—2008).Eligible studies were randomized,placebo-controlled of ACEI or ACEI alone trials versus the combination in patients with chronic heart failure.The quality of included studies was evaluated and meta-analysis was performed by RevMan 5.0 software.Results Seven randomized controlled trials(RCTs) that enrolled 5 853 patients met the enrollment criteria.A total of 2 945 patients received combination therapy,and 2 908 patients received ACEI only.The meta-analysis did not show statistical significance when comparing the deaths from any cause and the hospital admissions for any cause.But there was significantly difference in the combined endpoints of deaths or hospitalizations for any reason(RR:0.94;95%CI:0.90 to 0.98) the hospital admissions for CHF(RR:0.86;95%CI:0.79 to 0.93)and an increased risk of developing any adverse effect(RR:1.40;95%CI:1.24 to 1.58).Conclusion The current accumulative evidence shows that patients with chronic heart failure already receiving ACEI could benefit from additional ARB,but the combination of ACEI and ARB had an increased risk of developing any adverse effect.We suggest ARB should be cautiously added to ACEI therapy for patients with CHF.If chosen,the combination strategy needs closer patient monitoring for adverse effects.