ACEI/ARB治疗左室射血分数正常性心力衰竭的系统评价

摘要

Objective To evaluate the effects of ACEI or ARB in patients with heart failure but normal ejection fraction ( HFNEF ). Methods Cochrane Central Register of Controlled Trail, MEDLINE, EMBASE and Wanfang data were searched to find the randomized controlled trails ( RCT ) which comparing ACEI or ARB therapy with placebo, these papers were published between November 2001 and November 2011. Then calculate the odds ratio ( OR ) values and 95% confidence interval. Meta analysis was performed using RevMan 5. 025 software. Results Four RCT which satisfied the criteria were enrolled. The pooled OR value was 0. 99 and 95% confidence interval of overall mortality was 0. 87 ~ 1. 20 respectively; the pooled OR value was 1. 02 and 95% confidence interval of cardiovascular mortality was 0. 87 ~ 1. 20 respectively; the pooled OR value was 0. 97 and 95% confidence interval of hospitalization was 0. 88 ~ 1. 32 respectively; the pooled OR value was 1.03 and 95% confidence interval of cardiac function deterioration was 0. 80 ~ 1. 32 respectively, there was no significance between the 2 groups( P > 0. 05 ). Conclusion There is no significant difference between ACEI and ARB therapy in overall mortality, cardiovascular mortality, hospitalization and worsening heart failure in HFNEF patients.%目的 系统评价ACEI或ARB对射血分数正常性心力衰竭(HFNEF)的治疗是否有益.方法 检索2001年11月-2011年11月Cochrane Central Register of Controlled Trails 、MEDLINE、EMBASE和万方数据库中关于ACEI或ARB和安慰剂的随机对照试验(RCT),计算出优势比(OR)和OR的95%可信区间.对符合质量标准的RCT进行Meta分析.结果 共4个RCT符合条件纳入Meta分析.ACEI或ARB组与安慰剂组总病死率的OR值为0.99,95%可信区间为(0.87~1.14),2组差异无统计学意义(P﹥0.05);ACEI或ARB组与安慰剂组治疗心脏原因死亡的OR值为1.02,95%可信区间为(0.87~1.20),2组差异无统计学意义(P﹥0.05); ACEI或ARB组与安慰剂组住院率OR值为0.97,95%可信区间为(0.88~1.07),2组差异无统计学意义(P﹥0.05);ACEI或ARB组与安慰剂组心力衰竭恶化的OR值为1.03,95%可信区间为(0.80~1.32),2组差异无统计学意义(P﹥0.05).结论 ACEI或ARB组与对照组间在降低HFNEF的总病死率、心脏原因病死率、住院率和心力衰竭恶化方面没有统计学差异.