远端缺血预处理对高危患者行经皮冠状动脉介入诊疗后肾功能影响的Meta分析

Efficacy of Remote Ischemic Preconditioning Before Coronary Angiography or Percutaneous Coronary Intervention on Postoperative Renal Function in High Risk Patients:a Meta-analysis

目的:系统评价远端缺血预处理(RIPC)对高危患者行冠状动脉造影或经皮冠状动脉介入治疗(PCI)后肾功能的影响。方法:检索EMbase、PubMed、Cochrane library、中国知网等数据库,选取2010年1月1日至2019年3月1日有关高危患者在冠状动脉造影或PCI前行RIPC后对肾功能影响的随机对照试验(RCT),获得相关数据后应用RevMan 5.3软件进行Meta分析。结果:最终纳入12项RCT共包括1386例患者。Meta分析结果显示,与对照组相比,RIPC组术后对比剂肾病的发生风险显著降低(RR=0.47,95%CI:0.36~0.62,P<0.00001);RIPC组术后48 h时血肌酐水平明显低于对照组(MD=-0.11,95%CI:-0.18^-0.05,P=0.0004);RIPC组术后6周内死亡风险亦明显低于对照组(RR=0.25,95%CI:0.07~0.88,P=0.03),但两组在术后肾脏替代治疗可能性(RR=0.57,95%CI:0.12~2.63,P=0.47)和再次入院风险(RR=0.65,95%CI:0.42~1.01,P=0.06)方面差异均无统计学意义。结论:RIPC能显著降低高危患者在冠状动脉造影或PCI后对比剂肾病的发生,保护肾功能,降低近期死亡率。

Objectives:The aim of this study was to determine the effect of remote ischemic preconditioning(RIPC)on postoperative renal function in high risk patients undergoing coronary angiography/percutaneous coronary intervention(CAG/PCI).Methods:EMbase,PubMed,Cochrane Library and CNKI databases from January 2010 to March 2019 were searched for randomized controlled trials(RCTs)that assessed the effect of remote ischemic preconditioning(RIPC)on postoperative renal function in high risk patients undergoing CAG/PCI and meta-analysis was performed by RevMan 5.3.Results:12 RCTs with a total of 1386 participants were included in this meta-analysis.The results suggested that RIPC significantly reduced the incidence of postoperative contrast nephropathy(CIN)compared with control group(RR=0.47,95%CI:0.36-0.62,P<0.00001).The serum creatinine(SCr)level in RIPC group at 48 hours after operation was significantly lower than that in control group(MD=-0.11,95%CI:-0.18--0.05,P=0.0004);the postoperative mortality within six weeks in RIPC group was also significantly lower than that in control group(RR=0.25,95%CI:0.07-0.88,P=0.03).However,there was no significant difference in the rate of postoperative renal replacement therapy(RR=0.57,95%CI:0.12-2.63,P=0.47)and the rate of re-admission(RR=0.65,95%CI:0.42-1.01,P=0.06).Conclusions:This meta-analysis suggests that RIPC can significantly reduce the occurrence of CIN in high-risk patients undergoing CAG/PCI,protect renal function and reduce short-term mortality.