M.N., School of Nursing, Sun Yat-sen University, Guangzhou, China.
M.N., Nursing Department, Lingnan Branch of the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Ann Vasc Surg. 2022 May;82:347-361. doi: 10.1016/j.avsg.2021.12.073. Epub 2022 Jan 5.
Several RCTs have been conducted to assess the efficacy and safety of angiotensin receptor blocker (ARB) and beta-blocker (BB) therapy for Marfan syndrome (MFS), but the existing evidence is limited and conflicting. This study aimed to compare the efficacy and safety of different therapies.
The PubMed, Embase, Web of Science, and Cochrane Library databases were electronically searched up to March 2021 to retrieve randomized controlled trials regarding the efficacy and safety of ARB-related (including ARB-only and ARB+BB treatment) and BB-only treatment for treating patients with MFS. The revised risk-of-bias tool was used for quality assessment. The odds ratio (OR) and standard mean difference (SMD) with 95% confidence interval (CI) were used to estimate the pooled effect size.
Fourteen reports of 9 trials involving 1,449 patients were included in the meta-analysis. Regarding aortic root dilation, the ARB-related regimen has efficacy comparable with that of the BB-only regimen in patients with MFS (pooled SMD = -0.16, 95% CI [-0.33; 0.01]; P = 0.06), while in the ARB+BB vs. BB-only subgroup, a significant difference was observed (pooled SMD = -0.26; 95% CI [-0.40; -0.11]; P < 0.01). In addition, there were no significant differences in other aortic dilation-related measures (aortic root Z scores, ascending aorta, pulmonary artery, aortic annulus, sinotubular junction, aortic arch, thoracic aorta, and abdominal aorta diameter change) or cardiovascular events (aortic dissection, aortic surgery, and death) between the 2 regimens.
Our results showed that the clinical efficacy of ARB-only therapy is not inferior to that of BB-only therapy. Moreover, ARB+BB therapy showed superior therapeutic effects without significant adverse effects.
已有多项随机对照试验（RCT）评估血管紧张素受体阻滞剂（ARB）和β受体阻滞剂（BB）治疗马凡综合征（MFS）的疗效和安全性，但现有证据有限且存在争议。本研究旨在比较不同治疗方法的疗效和安全性。
检索 PubMed、Embase、Web of Science 和 Cochrane Library 数据库，检索时限截至 2021 年 3 月，收集 ARB 相关治疗（包括 ARB 单药和 ARB+BB 治疗）和 BB 单药治疗 MFS 患者的疗效和安全性的 RCT。采用修订后的偏倚风险工具进行质量评估。采用比值比（OR）和标准化均数差（SMD）及其 95%置信区间（CI）评估汇总效应量。
纳入 9 项研究的 14 份报告，共 1449 例患者。在主动脉根部扩张方面，ARB 相关方案与 BB 单药方案治疗 MFS 患者的疗效相当（汇总 SMD=-0.16，95%CI[-0.33;0.01]；P=0.06），而在 ARB+BB 与 BB 单药亚组中，差异具有统计学意义（汇总 SMD=-0.26；95%CI[-0.40;-0.11]；P<0.01）。此外，两种方案在其他与主动脉扩张相关的指标（主动脉根部 Z 评分、升主动脉、肺动脉、主动脉瓣环、窦管交界、主动脉弓、胸主动脉和腹主动脉直径变化）或心血管事件（主动脉夹层、主动脉手术和死亡）方面也无显著差异。
我们的结果表明，ARB 单药治疗的临床疗效并不逊于 BB 单药治疗。此外，ARB+BB 治疗在无明显不良反应的情况下具有更好的治疗效果。
