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Circulation-Heart Failure：射血分数降低的心衰患者药物治疗效果三十年证据汇总！

2017-01-14 xing.T MedSci原创

射血分数降低的心衰
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该网络荟萃分析结果显示采用ACEI、ARB、BB、MRA、ARNI及其组合治疗比安慰剂能更好地降低全因死亡率，除了ARB单药治疗和ARB加ACEI治疗外。联合ARNI+BB+MRA可以最大程度地降低患者死亡率。

减少射血分数降低的心衰患者的死亡率和发病率的治疗策略，包括血管紧张素转换酶抑制剂（ACEI）、血管紧张素受体拮抗剂（ARB）、β-受体阻滞剂（BB）、盐皮质激素受体拮抗剂（MRA）、血管紧张素受体–脑啡肽酶抑制剂（ARNI），还没有按照逐一比较的方式进行过研究。近日，心血管领域权威杂志Circulation: Heart Failure上发表了一篇荟萃分析文章，旨在比较这些药物及其组合对射血分数降低心衰患者的全因死亡率的疗效。

研究人员确定了57项在1987年至2015年期间发表的随机对照试验，并对其进行了系统的文献回顾；比较了研究和患者特征、基线风险、结局的定义以及观察到的治疗效果。尽管在研究时间、纽约心脏协会分级、射血分数以及有无使用地高辛等方面存在差异，网络荟萃分析被认为是可行的，同时对所有的试验进行了分析。

网络荟萃分析的随机效应表明，联合ACEI+BB+MRA相比于安慰剂组可减少56%病死率（风险比为0.44，95%可信区间为0.26-0.66）；相比于安慰剂组，联合ARNI+BB+MRA可以最大程度地降低全因死亡率（风险比为0.37，95%可信区间为0.19-0.65）。没有考虑背景治疗的敏感性分析建议ARNI单药治疗比ACEI或ARB单药治疗更有效果。

该网络荟萃分析结果显示采用ACEI、ARB、BB、MRA、ARNI及其组合治疗比安慰剂能更好地降低全因死亡率，除了ARB单药治疗和ARB加ACEI治疗外。联合ARNI+BB+MRA可以最大程度地降低患者死亡率。

原始出处：

Heather Burnett, et al. Thirty Years of Evidence on the Efficacy of Drug Treatments for Chronic Heart Failure With Reduced Ejection Fraction. Circulation: Heart Failure. 

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status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=170513, encodeId=c4131e05137c, content=学习了，收益, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7LIiaRZTzJ3SEfiauCzTMPW7YvPPYLNJBXG9oh6Al1icq2VQQkIHWxqXehcicTS62YKJVBhxeth3wggw/0, createdBy=7ce01621306, createdName=天涯183, createdTime=Sun Jan 15 11:57:39 CST 2017, time=2017-01-15, status=1, ipAttribution=)]
    2017-06-20 jxrzshh

    #治疗效果#

    0

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    2017-02-14 amy0550

    #failure#

    0

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status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=170513, encodeId=c4131e05137c, content=学习了，收益, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7LIiaRZTzJ3SEfiauCzTMPW7YvPPYLNJBXG9oh6Al1icq2VQQkIHWxqXehcicTS62YKJVBhxeth3wggw/0, createdBy=7ce01621306, createdName=天涯183, createdTime=Sun Jan 15 11:57:39 CST 2017, time=2017-01-15, status=1, ipAttribution=)]
    2017-01-24 李东泽

    很好，不错，以后会多学习

    0

  4. 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topicName=ART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Mon Jan 16 08:25:00 CST 2017, time=2017-01-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1373329, encodeId=d47e13e3329bf, content=<a href='/topic/show?id=2fd051939ab' target=_blank style='color:#2F92EE;'>#心衰患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51939, encryptionId=2fd051939ab, topicName=心衰患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=467c360, createdName=yuanming7, createdTime=Mon Jan 16 08:25:00 CST 2017, time=2017-01-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1449234, encodeId=edf114492346b, content=<a href='/topic/show?id=2ff746814f0' target=_blank style='color:#2F92EE;'>#射血分数降低#</a>, beContent=null, objectType=article, channel=null, level=null, 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href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80d715270048, createdName=slcumt, createdTime=Mon Jan 16 08:25:00 CST 2017, time=2017-01-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=170567, encodeId=1f4d1e05679f, content=很不错，谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zSn0GqHrsfLK1wzJZRTON4gxYUibhUyOypBwMibC4R7SsppicGhz5Ogoy0VVq4CWnqaD2Moeib8RWxI5lOiaVmnxpan/0, createdBy=c53f1730331, createdName=tanxingdoctor, createdTime=Sun Jan 15 19:20:38 CST 2017, time=2017-01-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=170513, encodeId=c4131e05137c, content=学习了，收益, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7LIiaRZTzJ3SEfiauCzTMPW7YvPPYLNJBXG9oh6Al1icq2VQQkIHWxqXehcicTS62YKJVBhxeth3wggw/0, createdBy=7ce01621306, createdName=天涯183, createdTime=Sun Jan 15 11:57:39 CST 2017, time=2017-01-15, status=1, ipAttribution=)]
    2017-01-16 zhaojie88

    #ART#

    0

  5. 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topicName=ART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Mon Jan 16 08:25:00 CST 2017, time=2017-01-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1373329, encodeId=d47e13e3329bf, content=<a href='/topic/show?id=2fd051939ab' target=_blank style='color:#2F92EE;'>#心衰患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51939, encryptionId=2fd051939ab, topicName=心衰患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=467c360, createdName=yuanming7, createdTime=Mon Jan 16 08:25:00 CST 2017, time=2017-01-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1449234, encodeId=edf114492346b, content=<a href='/topic/show?id=2ff746814f0' target=_blank style='color:#2F92EE;'>#射血分数降低#</a>, beContent=null, objectType=article, channel=null, level=null, 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href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80d715270048, createdName=slcumt, createdTime=Mon Jan 16 08:25:00 CST 2017, time=2017-01-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=170567, encodeId=1f4d1e05679f, content=很不错，谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zSn0GqHrsfLK1wzJZRTON4gxYUibhUyOypBwMibC4R7SsppicGhz5Ogoy0VVq4CWnqaD2Moeib8RWxI5lOiaVmnxpan/0, createdBy=c53f1730331, createdName=tanxingdoctor, createdTime=Sun Jan 15 19:20:38 CST 2017, time=2017-01-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=170513, encodeId=c4131e05137c, content=学习了，收益, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7LIiaRZTzJ3SEfiauCzTMPW7YvPPYLNJBXG9oh6Al1icq2VQQkIHWxqXehcicTS62YKJVBhxeth3wggw/0, createdBy=7ce01621306, createdName=天涯183, createdTime=Sun Jan 15 11:57:39 CST 2017, time=2017-01-15, status=1, ipAttribution=)]
    2017-01-16 yuanming7

    #心衰患者#

    0

  6. 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status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=170513, encodeId=c4131e05137c, content=学习了，收益, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7LIiaRZTzJ3SEfiauCzTMPW7YvPPYLNJBXG9oh6Al1icq2VQQkIHWxqXehcicTS62YKJVBhxeth3wggw/0, createdBy=7ce01621306, createdName=天涯183, createdTime=Sun Jan 15 11:57:39 CST 2017, time=2017-01-15, status=1, ipAttribution=)]
    2017-01-16 lmm399

    #射血分数降低#

    0

  7. 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topicName=ART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Mon Jan 16 08:25:00 CST 2017, time=2017-01-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1373329, encodeId=d47e13e3329bf, content=<a href='/topic/show?id=2fd051939ab' target=_blank style='color:#2F92EE;'>#心衰患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51939, encryptionId=2fd051939ab, topicName=心衰患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=467c360, createdName=yuanming7, createdTime=Mon Jan 16 08:25:00 CST 2017, time=2017-01-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1449234, encodeId=edf114492346b, content=<a href='/topic/show?id=2ff746814f0' target=_blank style='color:#2F92EE;'>#射血分数降低#</a>, beContent=null, objectType=article, channel=null, level=null, 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href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80d715270048, createdName=slcumt, createdTime=Mon Jan 16 08:25:00 CST 2017, time=2017-01-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=170567, encodeId=1f4d1e05679f, content=很不错，谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zSn0GqHrsfLK1wzJZRTON4gxYUibhUyOypBwMibC4R7SsppicGhz5Ogoy0VVq4CWnqaD2Moeib8RWxI5lOiaVmnxpan/0, createdBy=c53f1730331, createdName=tanxingdoctor, createdTime=Sun Jan 15 19:20:38 CST 2017, time=2017-01-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=170513, encodeId=c4131e05137c, content=学习了，收益, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7LIiaRZTzJ3SEfiauCzTMPW7YvPPYLNJBXG9oh6Al1icq2VQQkIHWxqXehcicTS62YKJVBhxeth3wggw/0, createdBy=7ce01621306, createdName=天涯183, createdTime=Sun Jan 15 11:57:39 CST 2017, time=2017-01-15, status=1, ipAttribution=)]
    2017-01-16 fusion

    #射血分数降低的心衰#

    0

  8. 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status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=170513, encodeId=c4131e05137c, content=学习了，收益, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7LIiaRZTzJ3SEfiauCzTMPW7YvPPYLNJBXG9oh6Al1icq2VQQkIHWxqXehcicTS62YKJVBhxeth3wggw/0, createdBy=7ce01621306, createdName=天涯183, createdTime=Sun Jan 15 11:57:39 CST 2017, time=2017-01-15, status=1, ipAttribution=)]
    2017-01-16 slcumt

    #HEART#

    0

  9. 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status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=170513, encodeId=c4131e05137c, content=学习了，收益, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7LIiaRZTzJ3SEfiauCzTMPW7YvPPYLNJBXG9oh6Al1icq2VQQkIHWxqXehcicTS62YKJVBhxeth3wggw/0, createdBy=7ce01621306, createdName=天涯183, createdTime=Sun Jan 15 11:57:39 CST 2017, time=2017-01-15, status=1, ipAttribution=)]
    2017-01-15 tanxingdoctor

    很不错，谢谢分享

    0

  10. 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status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=170513, encodeId=c4131e05137c, content=学习了，收益, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7LIiaRZTzJ3SEfiauCzTMPW7YvPPYLNJBXG9oh6Al1icq2VQQkIHWxqXehcicTS62YKJVBhxeth3wggw/0, createdBy=7ce01621306, createdName=天涯183, createdTime=Sun Jan 15 11:57:39 CST 2017, time=2017-01-15, status=1, ipAttribution=)]
    2017-01-15 天涯183

    学习了，收益

    0

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