CAJ | 학술논문

目的：评价醛固酮受体拮抗剂( ARA)对轻-中度心衰的有效性及安全性。方法通过计算机检索PubMed、Cochrane library、EMBase、万方数据库、中国生物医学文献数据库、维普中文数据库、中国期刊全文数据库,时间从建库至2014年3月前发表的关于ARA在NYHAⅠ-Ⅱ级患者中的应用的随机对照试验研究,使用RevMan5.2统计软件进行Meta分析。结果共纳入7篇文献,Meta分析结果显示：使用ARA能降低心衰再住院率(OR=0.64,95%CI：0.54~0.76,P<0.01)、左室收缩末容积指数(SWD=-12.20 mL/m2,95%CI：-20.91~-3.45,P<0.01)、左室舒张末容积指数(SWD=18.91 mL/m2,-17.73~-0.10,P<0.05)及左室质量指数(SWD=10.95 g/m2,-15.49~-6.41,P<0.01),增加左室射血分数(SWD=4.69%,2.43~6.94,P<0.01),而副作用未见明显增加(男性乳房发育：OR=1.41,95%CI：0.71~2.82,P=0.33；高钾血症：OR=1.52,95%CI：0.98~2.36,P=0.06)。结论 ARA能逆转左室重构、提高心功能,降低轻中度心衰患者的心衰再住院率,而不明显增加副作用风险,临床上应提倡使用。
목적：평개철고동수체길항제( ARA)대경-중도심쇠적유효성급안전성。방법통과계산궤검색PubMed、Cochrane library、EMBase、만방수거고、중국생물의학문헌수거고、유보중문수거고、중국기간전문수거고,시간종건고지2014년3월전발표적관우ARA재NYHAⅠ-Ⅱ급환자중적응용적수궤대조시험연구,사용RevMan5.2통계연건진행Meta분석。결과공납입7편문헌,Meta분석결과현시：사용ARA능강저심쇠재주원솔(OR=0.64,95%CI：0.54~0.76,P<0.01)、좌실수축말용적지수(SWD=-12.20 mL/m2,95%CI：-20.91~-3.45,P<0.01)、좌실서장말용적지수(SWD=18.91 mL/m2,-17.73~-0.10,P<0.05)급좌실질량지수(SWD=10.95 g/m2,-15.49~-6.41,P<0.01),증가좌실사혈분수(SWD=4.69%,2.43~6.94,P<0.01),이부작용미견명현증가(남성유방발육：OR=1.41,95%CI：0.71~2.82,P=0.33；고갑혈증：OR=1.52,95%CI：0.98~2.36,P=0.06)。결론 ARA능역전좌실중구、제고심공능,강저경중도심쇠환자적심쇠재주원솔,이불명현증가부작용풍험,림상상응제창사용。
Objective To evaluate the efficiency and safety of aldosterone receptor antagonist( ARA) in patients with mild to mod-erate heart failure( HF) . Methods The following databases were searched, including PubMed, Cochrane library, EMBase, Wanfang data-base, CBMdisc, VIP database and CNKI from creation of database to March 2014 for randomized controlled trials ( RCTs) assessing the effects of ARA therapy in HF patients with NYHA classⅠ-Ⅱ, and a RevMan 5. 2 sotfware was used to analyze these data. Results Seven related papers were included. The result of Meta-analysis showed that using ARA reduced the readmission rate induced by HF(OR=0. 64, 95% CI:0. 54~0. 76, P<0. 01). And it also reduced left ventricular end-systolic volume index( LVESVI, SWD= -12. 20 mL/m2, 95% CI: -20. 91 ~ -3. 45, P <0. 01), left ventricular end -diastolic volume index( LVEDVI, SWD =18. 91 mL/m2, -17. 73 ~-0. 10, P<0. 05) and left ventricular mass index( LVMI, SWD=10. 95 g/m2, -15. 49~ -6. 41, P<0. 01), increased left ventricular ejection fraction(LVEF, SWD=4. 69%, 2. 43~6. 94, P<0. 01), and the side effects were not significantly increased( gynecomastia:OR=1. 41, 95% CI:0. 71~2. 82, P=0. 33;hyperkalemia:OR=1. 52, 95%CI:0. 98~2. 36,P=0. 06). Conclusion ARA can reverse left ventricular remodeling, improve the heart function and reduce the re-hospitalization rate induced by mild to moderate HF, and it doesn 't increase significantly the risk of producing the side effects. Hence, it should be advocated and applied in clinical practice.