血管紧张素转化酶抑制剂对造影剂相关肾损害影响的荟萃分析

Meta-analysis of effect of angiotensin converting enzyme inhibitor on the contrast-induced nephropathy

目的系统评价血管紧张素转化酶抑制剂(ACEI)治疗造影剂肾病(CIN)的疗效。方法计算机检索Pub Med、Science Direct、Cochrane图书馆、EMbase等,检索中国生物医学文献数据库(CBM)、中文科技期刊全文数据库、中国期刊全文数据库(CNKI)和万方数字化期刊全文库,按照纳入、排除标准选择文献、提取资料和进行质量评价后,采用Rev Man5.0软件进行Meta分析。结果共纳入10个随机对照研究(RCTs),合计1215例患者,Meta分析结果显示:采用固定模式进行分析,ACEI类药物能有效降低CIN的发生率[RR=0.58,95%CI:(0.37,0.91),P=0.02],采用随机模式进行分析,与对照组相比,ACEI并不能有效降低CIN的发生率[RR=0.59,95%CI:(0.32,1.07),P=0.08],造影前后估算的肾小球滤过率变化[MD=2.73,95%CI:(-0.65,6.11),P=0.11],血肌酐变化[MD=-2.78,95%CI:(-7.60,2.04),P=0.26],差异均无统计学意义。结论与常规水化治疗相比,ACEI类药物治疗CIN并无绝对的优势,但鉴于文献质量及研究设计,如果要真正评价ACEI类药物治疗CIN的疗效,还需要大样本、多中心的严格设计的高质量RCTs。

Objective To systematically evaluate the effect of angiotensin converting enzyme inhibitor（ACEI） on the contrast-induced nephropathy（CIN）. Methods The database of Pub Med, Science Direct, Cochrane and EMbase as well as CBM, Chinese Sci-tech Periodical Full-text Database, CKNI and Wan-fang were searched by the computer and the literature was selected as the inclusion and exclusion criteria. Meta-analysis was performed by the Rev Man5.0 after the materials were extracted and the quality was evaluated. Results 10 randomized controlled trails（RCTs） were included with a total of 1215 patients. It was shown by the results of the Meta-analysis： the incidence rate of CIN could be effectively decreased by the ACEI drugs with the fixed model analysis [RR=0.58, 95%CI：（0.37, 0.91）, P=0.02]; the incidence rate of CIN could not be effectively decreased by the ACEI drugs with the randomized model analysis compared with the control group [RR=0.59, 95%CI：（0.32, 1.07）, P=0.08], no statistical significance was presented in the changes of evaluated glomerular filtration rate before and after radiography[MD=2.73, 95% CI：（-0.65, 6.11）, P=0.11] and the changes of serum creatinine[MD=-2.78, 95%CI：（-7.60, 2.04）, P=0.26]. Conclusion Compared with conventional rehydration therapy, ACEI drugs present no absolute advantages in the treatment of CIN. However due to the literature quality and study design, high-qualified RCTs with large samples and multicenter as well as strict design are needed to evaluate the treatment effect of ACEI on the CIN.