From the Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA,
From the Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA.
QJM. 2015 Nov;108(11):879-84. doi: 10.1093/qjmed/hcv049. Epub 2015 Feb 19.
The objective of this meta-analysis was to evaluate the risk of anemia in patients who received renin-angiotensin system (RAS) inhibitors.
A literature search was performed using MEDLINE, EMBASE, and Cochrane Database of Systematic Reviews from inception through November, 2014. Studies that reported relative risks, odd ratios or hazard ratios comparing the anemia risk in patients who received angiotensin-converting-enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) vs. those who did not were included. We performed the prespecified sensitivity analysis including only only studies with confounder adjusted analysis. Pooled risk ratios (RRs) and 95% confidence interval (CI) were calculated using a random-effect, generic inverse variance method.
Seven studies (2 cohort and 5 cross-sectional studies) with 29,061 patients were included in the analysis to assess the risk of anemia and the RAS inhibitors use. The pooled RR of anemia in patients receiving ACEIs was 1.56 (95% CI, 1.40-1.73, I(2) = 17%). When meta-analysis was limited only to studies with confounder adjusted analysis, the pooled RR of anemia in patients using ACEIs was 1.57 (95% CI, 1.43-1.73, I(2) = 0%) The pooled RR of anemia in patients receiving ARBs was 1.60 (95% CI, 1.27-2.00, I(2) = 39%). The meta-analysis of studies with confounder adjusted analysis demonstrated the pooled RR of anemia in patients using ARBs of 1.59 (95% CI, 1.38-1.83, I(2) = 0%).
Our meta-analysis demonstrates an association between anemia and the use of RAS inhibitors. Hematological parameters should be monitored in patients treated with RAS inhibitors.
本荟萃分析的目的是评估接受肾素-血管紧张素系统（RAS）抑制剂治疗的患者发生贫血的风险。
通过检索 MEDLINE、EMBASE 和 Cochrane 系统评价数据库，从建库至 2014 年 11 月，查找关于比较接受血管紧张素转换酶抑制剂（ACEI）或血管紧张素 II 受体阻滞剂（ARB）治疗的患者与未接受 RAS 抑制剂治疗的患者贫血风险的相对风险、比值比或危险比的研究。我们进行了仅包括经混杂因素校正分析的研究的预设敏感性分析。采用随机效应、通用倒数方差法计算汇总风险比（RR）和 95%置信区间（CI）。
纳入 7 项研究（2 项队列研究和 5 项横断面研究）共 29061 例患者，评估 RAS 抑制剂使用与贫血风险。接受 ACEI 治疗的患者发生贫血的汇总 RR 为 1.56（95% CI，1.40-1.73，I²=17%）。当仅限于经混杂因素校正分析的研究进行荟萃分析时，接受 ACEI 治疗的患者发生贫血的汇总 RR 为 1.57（95% CI，1.43-1.73，I²=0%）。接受 ARB 治疗的患者发生贫血的汇总 RR 为 1.60（95% CI，1.27-2.00，I²=39%）。经混杂因素校正分析的研究的荟萃分析显示，接受 ARB 治疗的患者发生贫血的汇总 RR 为 1.59（95% CI，1.38-1.83，I²=0%）。
本荟萃分析表明贫血与 RAS 抑制剂的使用有关。接受 RAS 抑制剂治疗的患者应监测血液学参数。
