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

肾脏病与透析肾移植杂志 ›› 2014, Vol. 23 ›› Issue (3): 240-246.

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

出版日期:2014-06-28 发布日期:2014-07-02

The cardiac and kidney benefit of angiotensin-converting enzyme inhibitor and angiotensin II receptor blocker in peritionel dialysis patients by Meta analysis

Online:2014-06-28 Published:2014-07-02

摘要/Abstract

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ARB/ACEI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RevMan 5.1对入选试验进行meta分析。结果：9项研究纳入，荟萃分析结果如下：（1）ARB/ACEI组患者残余肾功能、24小时尿量、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<0.00001）、（WDM=197.66,95%CI 140.78～254.54,P<0.000001）（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=-1.51,95%CI -1.74～-1.29）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（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类药物可以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。

关键词: 血管紧张素转换酶抑制剂, 血管紧张素Ⅱ受体拮抗剂, 腹膜透析, 荟萃分析

Abstract:

Objectives： 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. Result：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% CI90.32~0.62)], [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.

Key words: Angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, peritoneal dialysis, Meta-analysis

罗富里|蔡得汉|杨林|等. 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[J]. 肾脏病与透析肾移植杂志, 2014, 23(3): 240-246.

LUO Fuli|CAI Dehan|YANG Lin|et al. The cardiac and kidney benefit of angiotensin-converting enzyme inhibitor and angiotensin II receptor blocker in peritionel dialysis patients by Meta analysis[J]. Chinese Journal of Nephrology, Dialysis & Transplantation, 2014, 23(3): 240-246.

[1]	顾怡钰, 杨昕宇, 徐明珠, 徐家梁, 张铭炀, 蒋廷波. 腹膜透析充分性对心脏结构和功能的影响[J]. 肾脏病与透析肾移植杂志, 2021, 30(1): 25-30.
[2]	成水芹, 俞雨生. 2020国际腹膜透析协会关于腹膜透析治疗成人急性肾损伤指南的解读[J]. 肾脏病与透析肾移植杂志, 2021, 30(1): 87-91.
[3]	成水芹,陈赟敏,周婷婷,张志宏,王芳,吕桂兰,王金泉,俞雨生. 体外徒手腹膜透析导管拔除术的临床应用[J]. 肾脏病与透析肾移植杂志, 2020, 29(6): 531-535.
[4]	成水芹,周婷婷,张志宏,陈赟敏,王芳,吕桂兰,王金泉,俞雨生. 超声引导下Seldinger法经皮穿刺腹膜透析置管术的临床应用[J]. 肾脏病与透析肾移植杂志, 2020, 29(5): 433-437.
[5]	张志宏,俞雨生. 长期腹膜透析包裹性腹膜硬化症风险预测及预防措施[J]. 肾脏病与透析肾移植杂志, 2020, 29(4): 381-385.
[6]	张志宏,俞雨生. 日间不卧床腹膜透析的优势与应用[J]. 肾脏病与透析肾移植杂志, 2020, 29(3): 270-274.
[7]	成水芹,张志宏,俞雨生. 远程监控在自动化腹膜透析患者中的应用[J]. 肾脏病与透析肾移植杂志, 2020, 29(3): 275-279.
[8]	俞雨生. 经皮穿刺置管：推动腹膜透析发展的新动力[J]. 肾脏病与透析肾移植杂志, 2020, 29(2): 142-143.
[9]	阳晓. 紧急腹膜透析在终末期肾病中的应用[J]. 肾脏病与透析肾移植杂志, 2020, 29(2): 144-145.
[10]	张晓辉. 紧急起始腹膜透析临床应用的体会[J]. 肾脏病与透析肾移植杂志, 2020, 29(2): 146-147.
[11]	张志宏，俞雨生. 腹膜透析液的器官保护作用[J]. 肾脏病与透析肾移植杂志, 2020, 29(2): 181-185.
[12]	陈伊文,王月芳,邓新,等. 腹膜透析患者的远期预后及影响因素[J]. 肾脏病与透析肾移植杂志, 2019, 28(5): 412-417.
[13]	张志宏,俞雨生. 腹膜透析早期技术失败的危险因素和处理[J]. 肾脏病与透析肾移植杂志, 2019, 28(5): 479-483.
[14]	成水芹,俞雨生. 腹膜透析相关腹膜炎的诊疗新进展[J]. 肾脏病与透析肾移植杂志, 2019, 28(2): 181-184.
[15]	王涵，俞雨生. 腹膜透析相关非典型致病菌腹膜炎[J]. 肾脏病与透析肾移植杂志, 2019, 28(1): 88-90.

ISSN 1006-298X CN 32-1425/R