Abstract：
Acute heart failure (AHF) often leads to unfavorable outcomes due to fluid overload. While diuretics are the cornerstone treatment, acetazolamide may enhance diuretic efficiency by reducing sodium reabsorption. We performed a systematic review and meta-analysis on the effects of acetazolamide as an add-on therapy in patients with AHF compared to diuretic therapy. PubMed, Embase, and Cochrane databases were searched for randomized controlled trials (RCT). A random-effects model was employed to compute mean differences and risk ratios. Statistical analysis was performed using R software. The GRADE approach was used to rate the certainty of the evidence. We included 4 RCTs with 634 patients aged 68 to 81 years. Over a mean follow-up of 3 days to 34 months, acetazolamide significantly increased diuresis (MD 899.2 mL; 95% CI 249.5 to 1549; p < 0.01) and natriuresis (MD 72.44 mmol/L; 95% CI 39.4 to 105.4; p < 0.01) after 48 h of its administration. No association was found between acetazolamide use and WRF (RR 2.4; 95% CI 0.4 to 14.2; p = 0.3) or all-cause mortality (RR 1.2; 95% CI 0.8 to 1.9; p = 0.3). Clinical decongestion was significantly higher in the intervention group (RR 1.35; 95% CI 1.09 to 1.68; p = 0.01). Acetazolamide is an effective add-on therapy in patients with AHF, increasing diuresis, natriuresis, and clinical decongestion, but it was not associated with differences in mortality.
摘要：
急性心力衰竭（AHF）通常由于液体超负荷而导致不利的结果。虽然利尿剂是治疗的基石，乙酰唑胺可以通过减少钠的重吸收来提高利尿效率。与利尿剂治疗相比，我们对乙酰唑胺作为AHF患者的附加治疗效果进行了系统评价和荟萃分析。PubMed,Embase,在Cochrane数据库中搜索随机对照试验(RCT).采用随机效应模型来计算平均差异和风险比。使用R软件进行统计学分析。等级方法用于对证据的确定性进行评级。我们纳入了4个RCTs，634例患者，年龄68至81岁。平均随访3天至34个月，乙酰唑胺在给药48小时后显着增加了利尿（MD899.2mL；95％CI249.5至1549；p<0.01）和利钠（MD72.44mmol/L；95％CI39.4至105.4；p<0.01）。乙酰唑胺的使用与WRF(RR2.4;95%CI0.4~14.2;p=0.3)或全因死亡率(RR1.2;95%CI0.8~1.9;p=0.3)无相关性。干预组的临床充血率明显高于干预组（RR1.35；95％CI1.09至1.68；p=0.01）。乙酰唑胺是AHF患者的有效附加疗法，增加利尿，利钠尿,和临床充血，但与死亡率差异无关.
