长期化疗相关心脏功能障碍的雷宁- ангиотензин-алдостерон阻塞方案的比较:一个网络元分析
Jiaqi Li1, Ainsley Ryan Yan Bin Lee2, Areeba Tariq2
1School of Clinical Medicine, University of Cambridge, Cambridge, UK.
Cardiovascular drugs and therapy
|June 14, 2023
概括
埃纳拉普利尔显著保护化学疗法诱导的心脏功能障碍,特别是抗逆循环素. 然而,当使用 antracycline 和 trastuzumab 时,renin-angiotensin-aldosterone 系统阻断剂并没有防止心脏问题.
科学领域:
- 心脏病学 心脏病学
- 在瘤学瘤学.
- 药理学 药理学是指药理学的学科.
背景情况:
- 癌症治疗方法如 antracyclines 和 trastuzumab 可以引起心脏毒性.
- 使用心力衰竭药物的预防措施已被探索,但缺乏直接比较.
- 列宁-血管酶-阿尔多斯特系统 (RAAS) 阻断剂是用于心力衰竭管理的一类药物.
研究的目的:
- 评估RAAS抑制剂 (ACE-I,ARB,MRA) 在预防化疗相关心脏功能障碍方面的疗效.
- 在接受 antracyclines 和/或 trastuzumab 的患者中比较不同RAAS 抑制剂的有效性.
主要方法:
- 在 2022 年 9 月 15 日之前对随机对照试验进行系统搜索.
- 贝叶斯网络元分析,比较19项研究 (1905名患者) 中13项干预措施.
- 主要结局:左心室喷射分数 (LVEF) 的风险和平均下降;次要结局:透缩功能,应变和生物标志物.
主要成果:
- 与安慰剂相比,只有埃纳拉普利尔显著降低了LVEF下降的风险 (RR 0.05).
- 埃纳拉普利的益处主要在于保护抗抗环素诱导的心脏毒性.
- 没有RAAS抑制剂在同时服用 antracycline和trastuzumab时,在预防心脏功能障碍方面表现出有效性.
结论:
- 埃纳拉普利可能有助于初级预防与 antracycline 治疗相关的心脏功能障碍.
- RAAS 抑制剂对其他心脏功能标志物或合并 antracycline/trastuzumab 治疗没有显示出确的益处.
- 需要进一步的研究来澄清RAAS抑制剂在预防复杂癌症治疗方案中心脏毒性的作用.
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