摘要
目的系统评价肾素．血管紧张素系统（RAS）阻滞剂对接受血管造影术患者发生造影剂肾病（CIN）的影响。方法用计算机检索Pubmed、Embase、Cochrane图书馆、万方数据库和中国知网，检索时间从建库至2015年7月。纳入有关RAS阻滞剂影响CIN发生的随机对照试验（RCT）和非随机对照试验。由两名研究员分别对纳入研究进行数据提取和质量评价。用Revman5．3软件进行Meta分析。结果共纳入9项随机对照研究和7项非随机对照研究，合计患者15897例，其中7490例接受RAS阻滞剂治疗，对照组8407例。Meta分析结果显示，血管紧张素转化酶抑制剂（ACEI）／血管紧张素受体拮抗剂（ARB）组患者CIN的发生率高于对照组（14．35％比12．13％，P=0．04）。对肾功能不全患者的进一步分析结果显示，ACEI／ARB组患者CIN发生率也高于对照组（12．23％比7．32％，P=0．02），且ACEI／ARB组患者血管造影术后Scr升高绝对值大于对照组（P：0．02）。结论RAS阻滞剂可增加接受血管造影术患者的CIN发生率，RAS阻滞剂可促进肾功能不全患者CIN的发生。
Objective To evaluate the effects of renin-angiotensin system （RAS） blockades [angiotensin-converting enzyme inhibitors （ACEI） and angiotensin II type 1 receptor blockers （ARB）]on contrast- induced nephropathy （CIN） in patients undergoing angiography. Methods Pubmed, Embase, Cochrane library, Wanfang database and CNKI were searched. The literature limited range was from their start year to July 2015. Randomized controlled trials （RCTs） and non- randomized controlled trials of renin- angiotensin system blockades in influencing CIN were assessed. Two investigators extracted data and performed quality analysis independently from all trials included. Rev man 5.3 software was used. Results 16 trials with a total of 15 897 patients were identified. There were 7490 patients who received renin- angiotensin system blockades and 8407 patients in control group. The meta analysis revealed a higher CIN incidence in ACEI/ARB group than that in control group （14.35% vs 12.13%, P=0.04, OR=1.44, 95%CI 1.01-2.04）. For patients with renal insufficiency, ACEI/ARB group had a higher CIN incidence than control group （12.23% vs 7.32%, P= 0.02, OR= 1.80, 95%CI 1.10-2.94）, and the serum creatinine changes in ACEI/ARB group were higher than those in control group. There was statistical difference in serum creatinine changes between groups （P=0.02, MD=0.08, 95%CI 0.02-0.15）. Conclusions Renin-angiotensin system blockades can increase the incidence of CIN in patients undergoing angiography. Renin- angiotensin system blockades can contribute to CIN for patients with renal insufficiency.
出处
《中华肾脏病杂志》
CAS
CSCD
北大核心
2016年第5期350-357,共8页
Chinese Journal of Nephrology
