肾移植受者使用肾素-血管紧张素-醛固酮抑制剂的短期和长期结局：一项随机对照试验的荟萃分析。

Short- and long-term outcomes with renin-angiotensin-aldosterone inhibitors in renal transplant recipients: A meta-analysis of randomized controlled trials.

作者信息

Liao Ruo-Xi, Lyu Xia-Fei, Tang Wen-Jiao, Gao Kai

机构信息

Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China.

Department of Radiology, West China Hospital, Sichuan University, Chengdu, China.

出版信息

Clin Transplant. 2017 Apr;31(4). doi: 10.1111/ctr.12917. Epub 2017 Feb 22.

DOI:10.1111/ctr.12917

PMID:28186357

Abstract

BACKGROUND

Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor type 1 blockers (ARBs) are often prescribed for renal transplant recipients (RTRs), but the outcomes of these medications in RTRs remain controversial.

METHODS

The PubMed, Embase, and Cochrane Library databases were systematically searched. Randomized controlled trials investigating the outcomes of ACEI/ARBs in RTRs were included for meta-analysis.

RESULTS

Twenty-two trials with 2242 patients were identified. After treatment for at least 12 months, ACEI/ARBs were associated with a decline in glomerular filtration rate (GFR) (weighed mean differences [WMD] -5.76 mL/min; 95% confidence intervals [CI]: -9.31 to -2.20) and a decrease in hemoglobin (WMD -9.81 g/L; 95% CI: -14.98 to -4.64). There were no significant differences in mortality between ACEI/ARB and non-ACEI/ARB groups (risk ratio [RR] 0.98, 95% CI: 0.58 to 1.76), nor in graft failure (RR 0.68, 95% CI: 0.38 to 1.32). After short-term treatment (less than 1 year), significant differences were found in changes of 24-hour proteinuria (WMD-0.57 g/d; 95% CI: -0.72 to -0.42) and serum potassium (WMD 0.25 mEq/L; 95% CI: 0.14 to 0.37) in ACEI/ARB groups compared to control arm, while these differences were not confirmed in the long run.

CONCLUSION

This meta-analysis indicates ACEI/ARBs may be prescribed to RTRs with GFR and hemoglobin being carefully monitored.

摘要

背景

血管紧张素转换酶抑制剂（ACEIs）和1型血管紧张素II受体阻滞剂（ARBs）常用于肾移植受者（RTRs），但这些药物在RTRs中的疗效仍存在争议。

方法

系统检索PubMed、Embase和Cochrane图书馆数据库。纳入研究ACEI/ARBs在RTRs中疗效的随机对照试验进行荟萃分析。

结果

共纳入22项试验，涉及2242例患者。治疗至少12个月后，ACEI/ARBs与肾小球滤过率（GFR）下降（加权平均差[WMD]-5.76 mL/min；95%置信区间[CI]：-9.31至-2.20）和血红蛋白降低（WMD -9.81 g/L；95% CI：-14.98至-4.64）相关。ACEI/ARB组与非ACEI/ARB组在死亡率（风险比[RR] 0.98，95% CI：0.58至1.76）和移植失败率（RR 0.68，95% CI：0.38至1.32）方面无显著差异。短期治疗（少于1年）后，与对照组相比，ACEI/ARB组在24小时蛋白尿变化（WMD -0.57 g/d；95% CI：-0.72至-0.42）和血清钾变化（WMD 0.25 mEq/L；95% CI：0.14至0.37）方面存在显著差异，但长期来看这些差异未得到证实。