嘌呤黄嘌呤氧化酶抑制剂不利于慢性心力衰竭的预后：一项荟萃分析。

Purine xanthine oxidase inhibitors are not conducive to the prognosis of chronic heart failure: a meta-analysis.

作者信息

Ye Lin, Xu Anyi, Huang Jianing, Zhang Yeyuan, Yao Jie, Wang Fang

机构信息

Department of Intensive Care Unit, Ningbo No. 2 Hospital, Haishu District, Northwest Street 41, Ningbo, 315010, Zhejiang, China.

The First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.

出版信息

Eur J Clin Pharmacol. 2025 May 10. doi: 10.1007/s00228-025-03848-0.

DOI:10.1007/s00228-025-03848-0

PMID:40346314

Abstract

BACKGROUND

According to previous studies, the efficacy of xanthine oxidase inhibitors (XOIs) in patients with chronic heart failure (CHF) is still controversial. Therefore, the purpose of this study was to investigate the efficacy of XOIs in patients with CHF.

METHODS

Up to July 2024, we searched PubMed, EMBASE, Medline, Web of Science, and Cochrane Library for studies on the efficacy of XOI in patients with CHF. The main results included all-cause mortality, cardiovascular (CV) mortality, and heart failure (HF) hospitalization rates. The results were evaluated by hazard ratio (HR) and 95% confidence interval (95% CI).

RESULTS

A total of eight studies were included in this meta-analysis, of which five were cohort studies and three were randomized controlled trials (RCTs). The total sample size was 301,345. The experimental group was exposed to allopurinol or hydroxypurinol. The all-cause mortality (HR = 1.26, 95% CI 1.05-1.51, p = 0.013) and CV mortality (HR = 1.58, 95% CI 1.17-2.14, p = 0.03) in the experimental group were higher than those in the control group. In terms of HF hospitalization, there was no difference between both groups (HR = 1.21, p = 0.292). Subgroup analysis showed that the CV hospitalization rate of the experimental group was higher than that of the control group, regardless of frequency and dose levels. The all-cause mortality in the low-dose group was higher than that in the control group (HR = 1.39, p = 0.033). The CV mortality of the low-dose group (HR = 1.55, p = 0.006) and the prevalent group (HR = 1.50, p = 0.042) was higher than that of the control group.

CONCLUSION

Purine XOI exposure may be unfavorable for the prognosis of CHF patients and is affected by the frequency and dose of use.

摘要

背景

根据以往研究，黄嘌呤氧化酶抑制剂（XOIs）在慢性心力衰竭（CHF）患者中的疗效仍存在争议。因此，本研究旨在探讨XOIs在CHF患者中的疗效。

方法

截至2024年7月，我们在PubMed、EMBASE、Medline、科学网和Cochrane图书馆中检索了关于XOIs在CHF患者中疗效的研究。主要结果包括全因死亡率、心血管（CV）死亡率和心力衰竭（HF）住院率。结果通过风险比（HR）和95%置信区间（95%CI）进行评估。

结果

本荟萃分析共纳入八项研究，其中五项为队列研究，三项为随机对照试验（RCTs）。总样本量为301,345。实验组接受别嘌醇或羟基嘌呤醇治疗。实验组的全因死亡率（HR = 1.26，95%CI 1.05 - 1.51，p = 0.013）和CV死亡率（HR = 1.58，95%CI 1.17 - 2.14，p = 0.03）高于对照组。在HF住院方面，两组之间无差异（HR = 1.21，p = 0.292）。亚组分析表明，无论使用频率和剂量水平如何，实验组的CV住院率均高于对照组。低剂量组的全因死亡率高于对照组（HR = 1.39，p = 0.033）。低剂量组（HR = 1.55，p = 0.006）和患病率组（HR = 1.50，p = 0.042）的CV死亡率高于对照组。