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本文摘自2014年5月刊JAMA Intern Med： ---------------------------------- Results Twenty-three of 35 identified trials compared ACEIs with placebo or active drugs (32?827 patients) and 13 compared ARBs with no therapy (controls) (23?867 patients). When compared with controls (placebo/active treatment), ACEIs significantly reduced the risk of all-cause mortality by 13% (RR, 0.87; 95% CI, 0.78-0.98), CV deaths by 17% (0.83; 0.70-0.99), and major CV events by 14% (0.86; 0.77-0.95), including myocardial infarction by 21% (0.79; 0.65-0.95) and heart failure by 19% (0.81; 0.71-0.93). Treatment with ARBs did not significantly affect all-cause mortality (RR, 0.94; 95% CI, 0.82-1.08), CV death rate (1.21; 0.81-1.80), and major CV events (0.94; 0.85-1.01) with the exception of heart failure (0.70; 0.59-0.82). Both ACEIs and ARBs were not associated with a decrease in the risk for stroke in patients with DM. Meta-regression analysis showed that the ACEI treatment effect on all-cause mortality and CV death did not vary significantly with the starting baseline blood pressure and proteinuria of the trial participants and the type of ACEI and DM. 研究结果：本meta分析最终纳入了35项临床研究，其中23项对ACEIs进行了安慰剂对比（32?827名受试者），13项对ARBs进行了空白对比（23?867名受试者）。与对照组相比（安慰剂/空白对照），ACEIs显著降低了以下指标：全因死亡率下降13%，心血管死亡率下降17%；主要心血管事件下降14%，其中心肌梗塞下降21%，心力衰竭下降19%。而ARBs并未降低以上指标。无论ACEIs还是ARBs均未降低糖尿病患者的脑卒中风险。荟萃-回归分析显示，ACEI对全因死亡率和心血管死亡率的作用并不受基线血压值和蛋白尿，以及ACEI药物种类和糖尿病分类的影响。 Conclusions and Relevance Angiotensin-converting enzyme inhibitors reduced all-cause mortality, CV mortality, and major CV events in patients with DM, whereas ARBs had no benefits on these outcomes. Thus, ACEIs should be considered as first-line therapy to limit excess mortality and morbidity in this population. 研究结论：血管紧张素转化酶抑制剂显著降低了糖尿病患者的全因死亡率、心血管死亡率和主要心血管事件风险。而ARBs则并未改善这些结局。因此，这些患者应选用ACEI作为一线药物，以降低其死亡和患病风险。 ---------------------------------- 【医学专业新闻】 【关注的方法】微信搜索medicalnews即可。 【我们的优势】文献的中文翻译或有趣病例。 【中英文对照】助您提高医学专业英语水平。 【内容最权威】内容摘自国外权威医学期刊。 点击 ↓ 阅读原文进入微官网，查看所有文献 |
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