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在腎上腺切除術或礦物皮質皮質受體對抗劑治療後,主要心血管不良事件:系統性評論和元分析
Chien-Wei Huang1,2,3, Tse-Ying Huang4, Ya-Fei Yang5
1Division of Nephrology, Department of Internal Medicine Kaohsiung Veterans General Hospital Kaohsiung Taiwan.
Journal of the American Heart Association
|February 3, 2025
概括
主要不良心血管事件 (MACE) 在治疗后的原发性阿尔多斯特症 (PA) 患者中发生的频率高于非PA高血压患者. 在降低MACE风险方面,上腺切除术比矿物质皮质类受体对抗剂 (MRA) 治疗更有效.
科学领域:
- 心脏病学 心脏病学
- 内分泌学 在内分泌学.
- 临床研究 临床研究
背景情况:
- 原发性阿尔多斯特隆症 (PA) 与心血管风险增加有关.
- 了解治疗后主要不良心血管事件 (MACE) 的发生率对于患者管理至关重要.
研究的目的:
- 为了调查PA患者在上腺切除术或矿物质皮质类受体抗剂 (MRA) 治疗后的MACE发病率.
- 为了比较上腺切除术与MRA治疗在减少MACE的疗效.
主要方法:
- 对20项涉及16,927名PA患者的研究进行了系统审查和元分析.
- 搜索了主要的数据库 (PubMed,Embase等) 在2024年4月15日之前.
- 利用随机效应模型与子组和元回归分析.
主要成果:
- 在接受治疗的PA患者中,MACE的综合发病率为2.20/100患者年,高于非PA高血压 (1.20/100患者年).
- 上腺切除术 (2.00/100患者年) 显示MACE发病率低于MRA治疗 (3.30/100患者年;P=0.017).
- 晚年和糖尿病显著增加了MACE风险;观察到的MACE风险最低是在血胆固醇活性为1.0-2.0 ng/mL/hr时.
结论:
- 接受治疗的PA患者的MACE发病率高于非PA高血压患者.
- 上腺切除术在减轻MACE风险方面比MRA治疗更有效.
- 优化血胆固醇活性和管理年龄和糖尿病是降低PA心血管风险的关键.
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