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血管紧张素转换酶抑制剂/血管紧张素Ⅱ受体拮抗剂与维持性腹膜透析患者心肾获益的Meta分析 被引量:9

The cardiac and kidney benefit of angiotensin-converting enzyme inhibitor and angiotensin Ⅱ receptor blocker in peritoneal dialysis patients by Meta analysis
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摘要 目的:系统评价维持性腹膜透析患者使用血管紧张素转换酶抑制剂(ACEI)/血管紧张素Ⅱ受体拮抗剂(ARB)类药物的心肾获益。方法:检索Medline、PubMed、Cochrane Library、中国期刊全文数据库、中国科技期刊数据库(维普)、万方数字化期刊全文数据库、中国生物医学文献数据库等数据库,手工检索相应文献,专业资料和网络信息,检索年限从建库至2013年12月,检索关于ACEI/ARB类药物对腹膜透析患者心肾功能影响的随机对照实验,使用RevMan5.1对入选试验进行Meta分析。结果:共纳入9项研究,荟萃分析结果如下:(1)ACEI/ARB组患者残余肾功能、24h尿量、尿素清除指数、肌酐清除率均优于对照组患者(WMD=0.47,95%CI 0.32~0.62,P<0.000 01)、(WDM=197.66,95%CI140.78~254.54,P<0.000 001)(WMD=0.11,95%CI 0.00~0.22,P=0.04);(WMD=4,95%CI-2.46~10.46,P=0.22)。(2)ACEI/ARB组患者舒张末期室间隔厚度低于对照组患者(WMD=-1.32,95%CI-2.17^-0.47,P=0.002),心室舒张末期容积小于对照组患者(WMD=-3.39,95%CI-4.26^-2.51,P<0.00001);左心室射血分数高于对照组患者但无统计学差异(WMD=0.60,95%CI-0.81~2.02,P=0.40);(3)ACEI/ARB组与对照组患者血清钾水平无明显差异(WMD=0.04,95%CI-0.015~0.23,P=0.67)。结论:荟萃分析证实ACEI/ARB类药物可延缓腹膜透析患者残余肾功能丢失,维持患者血流动力学稳定,保护心功能,延缓心肌重构。但缺乏数据证实ACEI/ARB类药物减少腹膜透析患者心血管事件发生,降低死亡率。 Objective:We conducted a systematic review to study the safety and efficacy of ACEI and ARB use in PD patients.Methodology:PubMed,MEDLINE,Cochrane Library,CNKI,weipu database,CBM,Wanfang database and other databases were searched.The qualities of included articles were assessed and then a meta-analysis was conducted by using RevMan 5.1 software.Results:Meta-analysis results were as follows:(1) The ACEI/ARB group have a higher renal function,KT/V,more 24 hours urine,and CrCL compared with the control group.The WMD respectively are [0.47 95%CI 90.32~0.62)],[197.66,95%CI (140.78~254.54)],[0.11,95%CI (0.00~0.22)] ; [4,95% CI (-2.46~ 10.46)] (2)The thickness of interventricular in ACEI/ARB group was thinner than the control group [WMD =-1.32,95%CI-2.17~-0.47,P =0.002],While the ventricular end-diastolic volume was smaller than the control group [WMD =-3.39,95%CI(-4.26,-2.51)]; Left ventricular eject fraction was higher in ACEI/ARB group.(3)No significant difference between the two group in serum potassium level [WMD =0.04,95% CI (-0.015 ~ 0.23)].Conclusion:In PD patients,the ACEI/ARB effectively slowed the loss of residual renal function,maintained the hemodynamics in stable,protected cardiac function,and delayed myocardial remodeling; But evidences for the use of ACEIs/ARBs for reduction of mortality and CV events was lacking.
出处 《肾脏病与透析肾移植杂志》 CAS CSCD 北大核心 2014年第3期240-246,共7页 Chinese Journal of Nephrology,Dialysis & Transplantation
关键词 腹膜透析 血管紧张素转换酶抑制剂 血管紧张素Ⅱ受体拮抗剂 荟萃分析 peritoneal dialysis angiotensin-converting enzyme inhibitors (ACEIs) angiotensin receptor blockers (ARB) Meta-analysis
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