作　　者： (韩若冰）; (项荣武）; (雷添淇）; (栾曾惠）; (杜闪闪）; (翟菲）;

机构地区： 沈阳药科大学生命科学与生物制药学院,辽宁沈阳110016

出　　处： 《沈阳药科大学学报》 2017年第8期701-709,共9页

摘　　要： 目的系统评价ACEI/ARB在接受冠状动脉造影或经皮介入诊疗的患者中对造影剂肾病(contrast-induced nephropathy,CIN)的影响。方法在Pub Med、中国知网(CNKI)、维普期刊数据库、万方数据库等中进行文献检索,搜集1989年1月至2016年3月发表的相关临床随机对照试验,由两名研究者根据纳入与排除标准独立进行文献筛选及资料提取,并使用Cochrane系统评价手册5.1.0中RCT的偏倚与风险评估工具对纳入文献进行方法学质量评价。采用Rev Man5.1.0及Stata12.0软件进行Meta分析。结果最终纳入12项临床随机对照试验,研究对象共计1 963例(治疗组1 007例,对照组956例)。Meta分析结果显示,试验组造影剂肾病发生率(4.93%)低于对照组(7.78%)(OR=0.61,95%CI:0.41~0.89,P=0.01),与对照组相比ACEI/ARB的应用提高了肾小球滤过率(MD=4.59,95%CI:1.75~7.43,P=0.002),造影前后血肌酐水平变化及血清尿素变化差异无统计学意义(MD=0.00,95%CI:-0.07~0.07,P=0.93;MD=-0.17,95%CI:-1.07~0.73,P=0.71)。结论 ACEI/ARB的应用可以降低造影剂肾病的发生率,并提高了肾小球滤过率,提示该类药物的使用对于接受造影的患者肾脏具有保护作用。 Objective To systematically evaluate the impact of ACEI/ARB on the occurrence of contrast- induced nephropathy （CIN） in patients undergoing coronary angiogram or percutaneous coronary intervention. Methods Databases of PubMed, CNKI, VIP, and Wan Fang were searched for randomized controlled trials （RCTs） published from January 1989 to March 2016. Two reviewers independently screened literature and extracted data according to the inclusive and exclusive criteria. The methodological quality of the included literature was assessed by using the RCT bias risk assessment tool in the Cochrane system member handbook 5.1.0. The Meta-analysis was performed by using RevMan 5.1.0 and Stata 12.0 software. Results Twelve RCTs were involved with 1963 patients, and 1007 patients were in the experimental group and 956 patients in the control group. The incidence of CIN in experimental group （4. 93% ） showed much lower than that in control group （ 7.78 % ） （ OR = 0. 61,95 % CI： 0. 41 - 0. 89, P = 0. 01 ）. The eGFR was significantly improved by ACEI/ARB treatment as well （ MD = 4. 59,95 % CI： 1.75 - 7.43, P = 0. 002）. Not many differences were found between experimental and control group referring to A SCr and ABUN （MD =0.00,95%CI： -0.07 -0.07,P =0. 93;MD = -0. 17,95%CI： - 1.07 -0.73,P =0. 71）. Conclusions Administration of ACEI/ARB could reduce the incidence of CIN and improve eGFR, indicating its renal protective effect of ACEI/ARB on patients undergoing angiogram.

关 键 词： 血管紧张素转化酶抑制剂 血管紧张素受体拮抗剂 造影剂肾病 随机对照试验 分析