摘要
目的射血分数保留性心力衰竭(heart failure with preserved ejection fraction,HFpEF)患者在我国心衰患者中较为普遍,目前的临床指南尚无明确的药物推荐,有必要对新型口服鸟苷酸环化酶(soluble guanylate cyclase,sGC)激动剂的疗效和安全性进行研究。本研究旨在探讨sGC激动剂治疗HFpEF患者的疗效和安全性。方法检索PubMed、Embase和The Cochrane Library数据库中截至2022年10月已发表的比较sGC激动剂与安慰剂用于HFpEF患者的随机对照试验。结果研究共纳入1756名HFpEF患者。与安慰剂相比,sGC激动剂改善了EuroQol 5维自我报告问卷(EuroQol Group 5-Dmensional Self-report Questionnaire,EQ-5D)指数评分[MD=0.07,95%CI(0.06,0.08),P<0.001]、堪萨斯城心肌病问卷物理限制评分[MD=9.99,95%CI(8.86,11.12),P<0.001]和6分钟步行距离测试评分[MD=7.11,95%CI(5.48,8.74),P<0.001]。未观察到对全因死亡率[RR=1.29,95%CI(0.67,2.50),P=0.45]和主要不良心血管事件风险[RR=1.16,95%CI(0.80,1.67),P=0.43]的影响。此外,sGC激动剂对E/e′[MD=-0.94,95%CI(-2.12,0.24),P=0.12]、E/A[MD=-0.07,95%CI(-0.14,0.28),P=0.52]、左心房容积[MD=-0.35,95%CI(-1.75,2.45,P=0.75)]、左室收缩末期容积[SMD=-3.57,95%CI(-22.36,29.5),P=0.79]和N-端B型利钠肽前体[SMD=-0.97,95%CI(-2.04,0.10),P=0.08]均无明显改善作用。结论sGC激动剂可显著改善运动耐量和生活质量,但对全因死亡率没有确定的有益影响,且对超声心动图的舒张功能参数也没有积极影响。
Objective Heart failure with preserved ejection fraction(HFpEF)are more common in patients with heart failure in China.Currently,there is no definitive drug recommendations for the effective treatment of patients with HFpEF in clinical guidelines.It is necessary to study the efficacy and safety of novel oral soluble guanylate cyclase(sGC)stimulators.The aim of this study was to investigate the efficacy and safety of sGC stimulators in patients with HFpEF.Methods We searched the published randomized controlled trials(RCTs)comparing sGC stimulators with placebo in patients with HFpEF from the database of PubMed,Embase and the Cochrane library up to October,2022.A total of 1756 individuals with HFpEF were included in this Meta-analysis.Results Compared with placebo,sGC stimulators improved EuroQol Group 5-Dmensional Self-report Questionnaire(EQ-5D)index score(MD=0.07,95%CI=0.06 to 0.08,P<0.001),the Kansas City Cardiomyopathy Questionnaire physical limitation score(KCCQ-PLS)(MD=9.99,95%CI=8.86 to 11.12,P<0.001)and 6-minute walk distance test(6MWT)score(MD=7.11,95%CI=5.48 to 8.74,P<0.001).No effects on the all-cause mortality(RR=1.29,95%CI=0.67 to 2.50,P=0.45)and the risk of Major Adverse Cardiovascular Events(MACEs)(RR=1.16,95%CI=0.80 to 1.67,P=0.43)were observed.Furthermore,sGC stimulators failed showing beneficial effects on E/e′ratio(MD=-0.94,95%CI=-2.12 to 0.24,P=0.12),E/A(MD=-0.07,95%CI=-0.14 to 0.28,P=0.52),left atrial volume(MD=-0.35,95%CI=-1.75 to 2.45,P=0.75),left ventricular end-systolic volume(SMD=-3.57,95%CI=-22.36 to 29.5,P=0.79),and N-terminal pro-B-type natriuretic peptide(NT-proBNP)(SMD=-0.97,95%CI=-2.04 to 0.10,P=0.08).Conclusion sGC stimulators significantly improve exercise tolerance and quality of life without confirmed beneficial effect on all-cause mortality and the diastolic functional parameters determined by echocardiography.
作者
胡方振
王杨淦
周雅文
曾庆红
Fang-Zhen HU;Yang-Gan WANG;Ya-Wen ZHOU;Qing-Hong ZENG(Department of Internal Medicine,Zhongnan Hospital of Wuhan University,Wuhan 430071,China)
出处
《数理医药学杂志》
CAS
2023年第6期464-474,共11页
Journal of Mathematical Medicine
基金
国家自然科学基金项目(82070348)。
