Liu Hongzhi, Luo Hongxing, Wang Suqin, Zhang Cong, Hao Jialiang, Gao Chuanyu
Department of Cardiology, Zhengzhou University People's Hospital, Zhengzhou, Henan, 450003, China.
Oncotarget. 2017 Sep 21;8(50):88189-88198. doi: 10.18632/oncotarget.21112. eCollection 2017 Oct 20.
To systematically review and synthesize the currently available evidence of aliskiren for the treatment of heart failure.
We systematically searched the Cochrane, Embase and PubMed databases to identify the randomized controlled trials (RCT) on the effects of aliskiren on heart failure. Data were synthesized with random effects model and presented in forest plot. Publication bias was evaluated with funnel plot. Heterogeneity was evaluated with Begg's test and Egger's test.
Of 124 studies, 6 RCT of 9845 heart failure patients were included for meta-analysis, including 3727 patients receiving aliskiren. Compared with the controls, aliskiren did not significantly reduce the all-cause mortality (1.02 [0.91-1.14], I = 0%) or cardiovascular mortality (1.02 [0.88-1.17], I = 7.3%) of heart failure patients. Total adverse events, renal dysfunction, hypotension and hyperkalaemia were not significantly different between the aliskiren group and control group. Begg's test and Egger's test indicated low heterogeneity. Funnel plots indicated low publication bias.
Aliskiren, either used alone or combined with standard medical therapy, does not significantly reduce the all-cause mortality or cardiovascular mortality of heart failure patients. Although aliskiren does not cause statistically higher adverse events, its adverse events may not be neglected.
系统评价和综合目前可用的关于阿利吉仑治疗心力衰竭的证据。
我们系统检索了Cochrane、Embase和PubMed数据库，以确定关于阿利吉仑对心力衰竭影响的随机对照试验（RCT）。数据采用随机效应模型进行综合，并以森林图呈现。采用漏斗图评估发表偏倚。采用Begg检验和Egger检验评估异质性。
在124项研究中，纳入6项RCT（共9845例心力衰竭患者）进行荟萃分析，其中3727例患者接受阿利吉仑治疗。与对照组相比，阿利吉仑未显著降低心力衰竭患者的全因死亡率（1.02[0.91 - 1.14]，I² = 0%）或心血管死亡率（1.02[0.88 - 1.17]，I² = 7.3%）。阿利吉仑组和对照组之间的总不良事件、肾功能不全、低血压和高钾血症无显著差异。Begg检验和Egger检验表明异质性较低。漏斗图表明发表偏倚较低。
阿利吉仑单独使用或与标准药物治疗联合使用时，均未显著降低心力衰竭患者的全因死亡率或心血管死亡率。虽然阿利吉仑在统计学上未导致更高的不良事件，但仍不可忽视其不良事件。
