比较沙库巴曲缬沙坦与ARB类药物对肾功能影响的Meta分析

doi:10.5246/jcps.2025.06.042

中国药学(英文版) ›› 2025, Vol. 34 ›› Issue (6): 556-565.DOI: 10.5246/jcps.2025.06.042

比较沙库巴曲缬沙坦与ARB类药物对肾功能影响的Meta分析

张建梅¹^,^#, 吕俊刚²^,^#, 付浩¹^,^#, 朱安琪², 胡凤英³, 沈兆媛⁴^,^*(), 王芳¹^,^*()

^1. 武警特色医学中心, 天津 300162
^2. 武警北京市总队医院, 北京 100027
^3. 唐山中心医院, 河北唐山 063000
^4. 联勤保障部队第987医院, 陕西宝鸡 721001

收稿日期:2025-01-10 修回日期:2025-02-23 接受日期:2025-03-18 出版日期:2025-07-03 发布日期:2025-07-03
通讯作者: 沈兆媛, 王芳

Meta-analysis of the impact of sacubitril/valsartan and ARB drugs on renal function

Jianmei Zhang¹^,^#, Jungang Lv²^,^#, Hao Fu¹^,^#, Anqi Zhu², Fengying Hu³, Zhaoyuan Shen⁴^,^*(), Fang Wang¹^,^*()

¹ Characteristic Medical Center of PAP, Tianjin 300162, China
² Beijing Corps Hospital of PAP, Beijing 100027, China
³ Tangshan Central Hospital, Tangshan 063000, Hebei, China
⁴ The 987th Hospital of the Joint Logistic Support Force, Baoji 721001, Shaanxi, China

Received:2025-01-10 Revised:2025-02-23 Accepted:2025-03-18 Online:2025-07-03 Published:2025-07-03
Contact: Zhaoyuan Shen, Fang Wang
About author:
^# Jianmei Zhang, Jungang Lv, and Hao Fu contributed equally to this work.
Supported by:
Hebei Medical Science Research Project (Grant No. 20221849).

摘要/Abstract

摘要：

本研究旨在评估沙库巴曲缬沙坦与ARB类药物治疗对合并或不合并心力衰竭患者肾功能的影响。通过计算机对中英文数据库进行文献检索与筛查, 包括the Cochrane Library、万方数据库、Pubmed、中国知网、Embase、Clinical Trials等主要的医学数据库, 检索时间均从建库至2024年03月。对于纳入的随机对照研究采用Cochrane偏倚风险评价工具对文献治疗进行分析评估, 并使用Review Manager 5.4系统评价分析软件进行数据分析, 其中二分类变量以相对危险度(Relative risk, RR)作为效应指标, 根据异质性的不同分别采用固定效应模型或随机效应模型合并效应量。最终纳入7篇符合要求的文献, 与ARB类药物相比, 沙库巴曲缬沙坦组治疗后肾功能恶化(RR = 0.70, 95% CI = 0.44~1.12, P = 0.14)、急性肾功能损伤(RR = 0.77, 95% CI = 0.59~1.00, P = 0.05)、终末期肾病(RR = 0.53, 95% CI = 0.30~0.96, P = 0.16)、血肌酐大于2.5 mg/dL(RR = 0.88, 95% CI = 0.68~1.15, P = 0.37)、eGFR降低25%以上发生率(RR = 0.89, 95% CI = 0.57~1.41, P = 0.63)、血钾>5.5 mmol/L发生率(RR = 1.23, 95% CI = 0.86~1.75, P = 0.26)、血钾>6.0 mmol/L发生率(RR = 1.06, 95% CI = 0.58~1.93, P = 0.86)无统计学差异, 但eGFR降低50%以上发生率显著降低(RR = 0.58, 95% CI = 0.34~0.99, P < 0.05)。提示沙库巴曲缬沙坦对肾脏具有较好的保护作用, 可更有效的降低肾功能恶化等风险, 并可能替代ARB类药物。

关键词: 缬沙坦, 血管紧张素转换酶抑制剂, 肾脏功能, 血管紧张素受体拮抗剂, Meta分析

Abstract:

To evaluate the effects of sacubitril/valsartan and ARB on renal function in patients with and without heart failure, we conducted a comprehensive literature search using both Chinese and English databases. These included the Cochrane Library, Wanfang Database, PubMed, CNKI, Embase, and Clinical Trials. The search encompassed studies published from the inception of the databases to March 2024. Randomized controlled studies meeting the inclusion criteria were assessed for bias using the Cochrane risk of bias assessment tool. Data were analyzed using Review Manager 5.4, with relative risk (RR) as the effect indicator. Depending on the heterogeneity of the studies, either a fixed-effects model or a random-effects model was employed to combine effect sizes. Seven studies met the inclusion criteria. Compared with ARB drugs, sacubitril/valsartan showed a reduction in the deterioration of renal function (RR = 0.70, 95% CI: 0.44–1.12, P = 0.14) and acute renal function injury (RR = 0.77, 95% CI: 0.59–1.00, P = 0.05). The risk of end-stage renal disease was also lower (RR = 0.53, 95% CI: 0.30–0.96, P = 0.16). For serum creatinine levels greater than 2.5 mg/dL, the RR was 0.88 (95% CI: 0.68–1.15, P = 0.37). For a reduction in eGFR of more than 25%, the RR was 0.89 (95% CI: 0.57–1.41, P = 0.63). The incidence of serum potassium levels greater than 5.5 mmol/L was not significantly different between the groups (RR = 1.23, 95% CI: 0.86–1.75, P = 0.26), nor was the incidence of serum potassium levels greater than 6.0 mmol/L (RR = 1.06, 95% CI: 0.58–1.93, P = 0.86). However, the incidence of eGFR decreasing by more than 50% was significantly reduced (RR = 0.58, 95% CI: 0.34–0.99, P < 0.05). In conclusion, sacubitril/valsartan demonstrated a protective effect on the kidneys, effectively reducing the risk of renal deterioration and presenting a potential alternative to ARB drugs.

Key words: Sakubactril valsartan, Angiotensin-converting enzyme inhibitors, Kidney function, Angiotensin receptor antagonist, Meta-analysis

Supporting:

张建梅, 吕俊刚, 付浩, 朱安琪, 胡凤英, 沈兆媛, 王芳. 比较沙库巴曲缬沙坦与ARB类药物对肾功能影响的Meta分析[J]. 中国药学(英文版), 2025, 34(6): 556-565.

Jianmei Zhang, Jungang Lv, Hao Fu, Anqi Zhu, Fengying Hu, Zhaoyuan Shen, Fang Wang. Meta-analysis of the impact of sacubitril/valsartan and ARB drugs on renal function[J]. Journal of Chinese Pharmaceutical Sciences, 2025, 34(6): 556-565.

图/表 5

Figure 1. Literature screening and inclusion process.

Table 1. General information of included literature.

Table 2. Clinical information of included literature.

Figure 2. Summary of risk of bias.

Figure 3. Results of meta-analysis on renal function deterioration.

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比较沙库巴曲缬沙坦与ARB类药物对肾功能影响的Meta分析

Meta-analysis of the impact of sacubitril/valsartan and ARB drugs on renal function

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