沙库巴曲缬沙坦对肾功能保护作用的系统评价和meta分析

Protective Effect of Sacubitril/Valsartan on Renal Function: Systematic Review and Meta-analysis

关键词:  沙库巴曲缬沙坦  肾功能  心力衰竭  慢性肾病  血管紧张素转换酶抑制剂  血管紧张素受体抑制剂

Key words:  sacubitril/valsartan  renal function  heart failure  chronic kidney disease  angiotensin-converting enzyme inhibitors  angiotensin receptor blockers

摘要:

目的 系统评价沙库巴曲缬沙坦相比血管紧张转换酶抑制剂(angiotensin-converting enzyme inhibitors,ACEI)或血管紧张素受体拮抗剂(angiotensin receptor blockers,ARB)对肾功能的保护作用。目的 方法检索万方、知网、PubMed、Embase、ClinicalTrials.gov和The Cochrane Library等数据库,收集使用沙库巴曲缬沙坦和ACEI/ARB治疗患者的随机对照试验。检索期限为自建库起至2021年6月12日。由2位研究者独立进行文献筛选、资料提取,根据Cochrane协作网系统评价员手册的风险偏倚评价工具对纳入研究进行评价,采用RevMan 5.3软件进行meta分析。将数据归纳为二分类变量和95%置信区间,采用I²检验评估异质性。目的 结果11项研究符合研究标准,包括18 966例患者。与ACEI/ARB相比,沙库巴曲缬沙坦降低肾功能恶化的风险[RR=0.89,95% CI (0.80,0.99),P=0.03];沙库巴曲缬沙坦可降低心衰患者肾功能恶化的风险[RR=0.87,95% CI (0.78,0.97),P=0.02],但不能降低非心衰患者肾功能恶化的风险[RR=1.04,95% CI (0.80,1.37),P=0.76];沙库巴曲缬沙坦降低了射血分数保留的心衰患者肾功能恶化的风险[RR=0.85,95% CI (0.74,0.97),P=0.02],降低了射血分数减低的心衰患者肾功能恶化的风险[RR=0.91,95% CI (0.75,1.10),P=0.34];在心衰患者中,沙库巴曲缬沙坦与ACEI相比降低了肾功能恶化的风险[RR=0.95,95% CI (0.83,1.10),P=0.51],与ARB相比降低了肾功能恶化的风险[RR=0.74,95% CI (0.61,0.89),P=0.002]。目的 结论本研究结果表明沙库巴曲缬沙坦对心衰患者的肾功能保护优于ACEI/ARB,但在不同心衰类型和对照药物中差异不同,而对非心衰患者的肾功能保护与ACEI/ARB相似

Abstract:

OBJECTIVE To systematically evaluate the protective effect of sacubitril/valsartan vs angiotensin-converting enzyme inhibitors/angiotensin retor blockers(ACEI/ARB) on renal function. METHODS Databases such as Wanfang, CNKI, PubMed, Embase, ClinicalTrials.gov and The Cochrane Library were searched to collect randomized controlled trials of patients treated with sacubitril/valsartan and ACEI/ARB. The retrieval period was from the self-established database to June 12, 2021. Literature screening and data extraction were conducted independently by two researchers. The included studies were evaluated according to the risk bias assessment tool in the Cochrane Collaborative System Rater's Manual, and meta-analysis was performed using RevMan 5.3 software. Summarize data into binary variables and 95% confidence interval the heterogeneity was assessed with the I² test. RESULTS The 11 studies met the study criteria, including 18 966 patients. Compared with ACEI/ARB, sacubitril/valsartan reduced the risk of worsening renal function[RR=0.89, 95%CI(0.80, 0.99), P=0.03]; sacubitril/valsartan reduced the risk of renal function deterioration in patients with HF[RR=0.87, 95%CI(0.78, 0.97), P=0.02], but it can't reduce the risk of renal function deterioration in patients with non-HF[RR=1.04, 95%CI(0.80, 1.37), P=0.76]; sacubitril/valsartan reduced the risk of renal function deterioration in heart failure patients with preserved ejection fraction[RR=0.85, 95%CI(0.74, 0.97), P=0.02], and reduced the risk of renal function deterioration in heart failure patients with reduced ejection fraction[RR=0.91, 95%CI(0.75, 1.10), P=0.34]; in patients with HF, sacubitril/valsartan reduced the risk of of renal function deterioration compared with ACEI[RR=0.95, 95%CI(0.83, 1.10), P=0.51], and it reduced the risk of renal function deterioration compared with ARB[RR=0.74, 95%CI(0.61, 0.89), P=0.002]. CONCLUSION This research provides evidence that sacubitril/valsartan has better protection of renal function in patients with heart failure than ACEI/ARB, but the differences were different among different heart failure types and control drug subgroups, while it is similar to ACEI/ARB in non-heart failure patients.