肾素-血管紧张素系统阻滞剂与造影剂肾病发生的Meta分析

摘要

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 trims 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 theincidence of CIN in patients undergoing angiography.Renin-angiotensin system blockades can contribute to CIN for patients with renal insufficiency.%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Rev man 5.3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15 897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ACE/AARB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.