Division of Medicine, Federal University of Santa Maria, Santa Maria, Brazil.
Division of Medicine, Federal University of Grande Dourados, Dourados, Brazil.
Heart Fail Rev. 2024 Sep;29(5):1039-1047. doi: 10.1007/s10741-024-10417-7. Epub 2024 Jul 10.
Acute heart failure (AHF) often leads to unfavorable outcomes due to fluid overload. While diuretics are the cornerstone treatment, acetazolamide may enhance diuretic efficiency by reducing sodium reabsorption. We performed a systematic review and meta-analysis on the effects of acetazolamide as an add-on therapy in patients with AHF compared to diuretic therapy. PubMed, Embase, and Cochrane databases were searched for randomized controlled trials (RCT). A random-effects model was employed to compute mean differences and risk ratios. Statistical analysis was performed using R software. The GRADE approach was used to rate the certainty of the evidence. We included 4 RCTs with 634 patients aged 68 to 81 years. Over a mean follow-up of 3 days to 34 months, acetazolamide significantly increased diuresis (MD 899.2 mL; 95% CI 249.5 to 1549; p < 0.01) and natriuresis (MD 72.44 mmol/L; 95% CI 39.4 to 105.4; p < 0.01) after 48 h of its administration. No association was found between acetazolamide use and WRF (RR 2.4; 95% CI 0.4 to 14.2; p = 0.3) or all-cause mortality (RR 1.2; 95% CI 0.8 to 1.9; p = 0.3). Clinical decongestion was significantly higher in the intervention group (RR 1.35; 95% CI 1.09 to 1.68; p = 0.01). Acetazolamide is an effective add-on therapy in patients with AHF, increasing diuresis, natriuresis, and clinical decongestion, but it was not associated with differences in mortality.
急性心力衰竭（AHF）常因液体超负荷而导致不良结局。利尿剂是心力衰竭的基石治疗方法，而乙酰唑胺通过减少钠重吸收可以增强利尿剂的效率。我们对乙酰唑胺作为心力衰竭患者附加治疗与利尿剂治疗的效果进行了系统评价和荟萃分析。我们检索了 PubMed、Embase 和 Cochrane 数据库中的随机对照试验（RCT）。采用随机效应模型计算均数差和风险比。使用 R 软件进行统计分析。采用 GRADE 方法评估证据的确定性。我们纳入了 4 项 RCT，共纳入了 634 名年龄为 68 至 81 岁的患者。在平均 3 天至 34 个月的随访中，乙酰唑胺在 48 小时后显著增加了尿量（MD 899.2 mL；95%CI 249.5 至 1549；p<0.01）和排钠量（MD 72.44 mmol/L；95%CI 39.4 至 105.4；p<0.01）。乙酰唑胺的使用与 WRF（RR 2.4；95%CI 0.4 至 14.2；p=0.3）或全因死亡率（RR 1.2；95%CI 0.8 至 1.9；p=0.3）之间没有关联。干预组的临床消肿效果明显更高（RR 1.35；95%CI 1.09 至 1.68；p=0.01）。乙酰唑胺是心力衰竭患者的有效附加治疗方法，可增加尿量、排钠量和临床消肿效果，但与死亡率无差异。
