摘要
目的系统评价联合使用血管紧张素转换酶抑制剂(ACEI)和血管紧张素Ⅱ受体拮抗剂(ARB)治疗慢性心力衰竭(CHF)的安全性和有效性。方法检索EMBase(1974-2011)、PubMed(1966-2011)、Cochrane图书馆(1995-2011)、中国期刊网数据库CNKI(1994-2011年)、VIP(1989-2011)、CBM(1978-2011)。纳入比较联合使用ACEI和ARB治疗慢性心力衰竭患者的随机对照试验,并应用RevMan5.0软件进行统计分析。结果共纳入16个随机对照试验。Meta分析结果,在左心室舒张末期内径减少量(WMD=-3.72,95%CI:-6.95～-0.48;P=0.02),6min步行试验的增加量(WMD=25.67,95%CI:4.74～46.61;P=0.02),心功能改善显效(RR=1.42,95%CI:1.06～1.88;P=0.02)等方面,ACEI联合ARB组显著优于单独使用ACEI组。心功能改善无效[RR=0.39,95%CI:0.22～0.71;P=0.002]方面,ACEI联合ARB组显著低于ACEI组。在左室收缩末期内径减少量、心率减少量、左室射血分数的增加量、心功能改善有效、不良反应、病死率方面,两组没有统计学差异。结论 ACEI联合ARB可显著提高6min步行的距离,改善心脏功能,而没有增加患者的不良反应和死亡率。本研究提示ACEI联合ARB可应用于慢性心力衰竭患者,但仍需高质量的前瞻性研究进一步证实。
Objective To review systemically the safety and effectiveness of integrated application of angiotensin-converting enzyme inhibitor（ACEI） and angiotensin receptor blocker（ARB） in treatment of chronic heart failure（CHF）.Methods The literature were retrieved from EMBase（1974~2011）,PubMed（1966~2011）,Cochrane（1995~2011）,CNKI（1994~2011）,VIP（1989~2011） and CBM（1978~2011）.The randomized controlled trials（RCT） of integrated application of ACEI and ARB intreatment of CHF were colleted and compared,and the data were analyzed by using RevMan 5.0 software.Results There were totally 16 randomized controlled trials collected.The results of Meta analysis showed that ACEI combining ARB group was superior to ACEI group in the decrease of LVEDd（WMD=-3.72,95%CI：-6.95^-0.48;P=0.02）,increase of 6-min walk test（WMD=25.67,95%CI：4.74~46.61;P=0.02）,and significant effectiveness in heart function improvement（RR=1.42,95%CI：1.06~1.88;P=0.02）.The ineffectiveness of heart function improvement（RR=0.39,95%CI：0.22~0.71;P=0.002） was significantly lower in ACEI combining ARB group than that in ACEI group.There were no statistical differences between two groups in the decrease of LVEsd and heart rate,increase of LVEF,effectiveness of heart function improvement,adverse reactions and mortality.Conclusion ACEI combining ARB can significantly prolong the distance of 6-min walk,improve heart function,and does not increase adverse reactions and mortality.ACEI combining ARB may be applied to the treatment of CHF,and further high-quality prospective studies are needed.
出处
《中国循证心血管医学杂志》
2011年第5期336-343,共8页
Chinese Journal of Evidence-Based Cardiovascular Medicine
