血管紧张素转换酶抑制剂或血管紧张素Ⅱ受体拮抗剂对完全性大动脉转位心房内板障术后右心室结构和功能影响的Meta分析

doi:10.3969/j.issn.1004-583X.2016.03.019

临床荟萃 ›› 2016, Vol. 31 ›› Issue (3): 307-314.doi: 10.3969/j.issn.1004-583X.2016.03.019

血管紧张素转换酶抑制剂或血管紧张素Ⅱ受体拮抗剂对完全性大动脉转位心房内板障术后右心室结构和功能影响的Meta分析

陈军辉^1a,苏鹏^1b,刘姝娆²,高霞^1a,宋攀³,杨建平⁴

1.甘肃省人民医院 a.儿科;b.心内科,甘肃兰州 730000;
2.甘肃中医药大学研究生学院,甘肃兰州 730000;
3.兰州大学临床医学院,甘肃兰州 730000;
4.会宁县第一人民医院儿科,甘肃会宁 730700

收稿日期:2015-11-30 出版日期:2016-03-05 发布日期:2016-04-18
通讯作者: 陈军辉,Email:chenjunhui008@sina.com
基金资助:
甘肃省卫生行业科研计划项目(GSWKY-2015-12)

Effect of angiotensin converting enzyme inhibitor or angiotensin Ⅱ receptor blocker on right ventricular structure and function in transposition of great arteries with intra-atrial baffle: a meta-analysis

Chen Junhui^1a, Su Peng^1b, Liu Shurao², Gao Xia^1a,Song Pan³, Yang Jianping⁴

1a. Department of Pediatrics;1b. Department of Cardiology, the People’s Hospital of Gansu, Lanzhou 730000, China;
2. Graduate School, Gansu University of Traditional Chinese Medicine, Lanzhou 730000, China;
3. School of Clinical Medicine, Lanzhou University, Lanzhou 730000, China;
4. Department of Pediatrics, the People’s Hospital of Huining, Huining 730700, China

Received:2015-11-30 Online:2016-03-05 Published:2016-04-18
Contact: Chen Junhui, Email: chenjunhui008@sina.com

摘要/Abstract

摘要： 目的对血管紧张素转换酶抑制剂或血管紧张素Ⅱ受体拮抗剂对完全性大动脉转位心房内板障术后,右心室结构和功能影响进行系统评价和meta分析。方法计算机检索PubMed、The Cochrane Library、Embase、Web of Science、CBM、CNKI、VIP 及WanFang Date 数据库,全面收集血管紧张素Ⅱ受体拮抗剂(ARB)血管紧张素转化酶抑制剂(ACEI)对完全性大动脉转位矫正术后,右心室结构和功能影响的多中心、随机、对照试验,检索时限均为建库至2015年,并追查纳入排除文献的参考文献。按照纳入与排除标准独立筛选文献、提取资料和评价质量后,采用RevMan 5.2软件进行meta分析。应用CONSORT声明对纳入RCT文献的报告质量进行综合评价。结果共纳入8篇文献,其中3项为随机对照试验,4项随机交叉对照,1项对照试验,225例患者。Meta分析结果显示,与安慰剂比较:ACEI或ARB在右心室射血分数(MD=-0.69,95%CI=-16.55~5.75,P=0.64);右心室舒张末期容积(MD=0.67,95%CI=-29.68~31.02,P=0.97);右心室收缩末期容积(MD=2.28,95%CI=-17.77~22.33,P=0.82);收缩压(MD=-2.92,95%CI=-7.92~2.08,P=0.25);最大摄氧量(MD=-0.14,95%CI=-1.85~1.58,P=0.88);血清钾(MD=0.11,95%CI=-0.01~0.24,P=0.07);肌酐(MD=0.87,95%CI=-4.25~5.98,P=0.74);心率(MD=-1.26,95%CI=-3.06~0.54,P=0.17);最大心率(MD=-3.35,95%CI=-12.95~6.25,P=0.49)。结论现有证据显示,ACEI或ARB对完全性大动脉转位矫正术后右心室结构和功能的影响与安慰剂相比,在右心室射血分数,右心室舒张末期容积,右心室收缩末期容积,收缩压,最大摄氧量,心率,最大心率,血清钾,肌酐没有显著差异,但在延缓心功能、肾功能恶化有一定效果,差异无统计学意义,纳入文献均未见明显不良反应报道,安全性较高。

关键词: 心脏缺损, 先天性, 血管紧张素转换酶抑制药, 血管紧张素Ⅱ受体拮抗剂, meta分析

Abstract: Objective To evaluate and analyze the effect of angiotensin converting enzyme inhibitor or angiotensin Ⅱ receptor antagonist on right ventricular structure and function in transposition of the great arteries with intra-atrial baffle.Methods A comprehensive search was conducted up until 2015 in the following databases: PubMed, Cochrane Library, Embase, Web of Science, CBM, CNKI, VIP and WanFang Database. Studies assessing the multi-center, randomized, controlled, double-blind trials (RCT) of the right ventricular structure and function in transposition of the great arteries with intra-atrial baffle treated with angiotensin Ⅱ receptor antagonist or angiotensin converting enzyme inhibitor were included. The articles in reference lists were also reviewed. Four reviewers screened literature, extracted data, and assessed quality of included studies according to the inclusion and exclusion criteria, independently. Meta-analysis was performed using RevMan 5.2 software and CONSORT statement was applicated to comprehensively evaluate the report quality included in RCT literature.Results A total of 8 studies were finally included involving 3 randomized controlled trials, 4 randomized crossover trials, 1 controlled trial and in total 225 patients. Meta analysis showed that, there was no significant difference in right ventrieular ejection fraction (RVEF) compared with the placebo (MD=-0.69, 95%CI=-16.55-5.75,P=0.64), right ventricular end-diastolic volume (RVEDV) (MD=0.67, 95%CI=-29.68-31.02,P=0.97), right ventricular end-systolic volume (RVESV) (MD=2.28, 95%CI=-17.77-22.33,P=0.82), systolic blood pressure (SBP) (MD=-2.92, 95%CI=-7.92-2.08,P=0.25), maximal oxygen uptake (VO_2max) (MD=-0.14, 95%CI=-1.85-1.58,P=0.88), serum potassium (MD=0.11, 95%CI=-0.01-0.24,P=0.07), creatinine(Cr) (MD=0.87,95%CI=-4.25-5.98,P=0.74), heart rate (HR) (MD=-1.26, 95%CI=-3.06-0.54,P=0.17) or HRmax (MD=-3.35, 95%CI=-12.95-6.25,P=0.49) between ACEI or ARB.Conclusion Current evidence demonstrated that there were no significant difference in RVEF, RVEDV, RVESV, VO_2max, HR, HRmax, serum potassium and Cr in transposition of the great arteries with intra-atrial baffle treated with angiotensin converting enzyme inhibitor or angiotensin Ⅱ receptor antagonist compared with placebo. There was significant difference in reducing the incidence of adverse cardiac events,however there were no significance in adverse reactions and higher safety.

Key words: heart defects, congenital, angiotensin-converting enzyme inhibitors, angiotensin Ⅱ type 2 receptor blockers, meta-analysis

中图分类号:

R541.1

陈军辉,苏鹏,刘姝娆,高霞,宋攀,杨建平. 血管紧张素转换酶抑制剂或血管紧张素Ⅱ受体拮抗剂对完全性大动脉转位心房内板障术后右心室结构和功能影响的Meta分析[J]. 临床荟萃, 2016, 31(3): 307-314.

Chen Junhui, Su Peng, Liu Shurao, Gao Xia,Song Pan, Yang Jianping. Effect of angiotensin converting enzyme inhibitor or angiotensin Ⅱ receptor blocker on right ventricular structure and function in transposition of great arteries with intra-atrial baffle: a meta-analysis[J]. Clinical Focus, 2016, 31(3): 307-314.

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https://huicui.hebmu.edu.cn/CN/Y2016/V31/I3/307

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血管紧张素转换酶抑制剂或血管紧张素Ⅱ受体拮抗剂对完全性大动脉转位心房内板障术后右心室结构和功能影响的Meta分析

Effect of angiotensin converting enzyme inhibitor or angiotensin Ⅱ receptor blocker on right ventricular structure and function in transposition of great arteries with intra-atrial baffle: a meta-analysis

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