ACEI/ARB对经皮冠脉介入诊疗后对比剂肾病影响的系统评价

Effects of angiotensin enzyme inhibitors and angiotensin receptor blockers therapy on contrast-induced nephropathy in patients undergoing PCI or CAG

摘要:

目的：评价血管紧张素转化酶抑制剂（angiotensin converting enzyme inhibitor，ACEI）或血管紧张素受体阻滞剂（angiotensin receptor blockers，ARB）在接受冠状动脉造影（coronary angiogram，CAG）或经皮冠脉介入（percutaneous coronary intervention，PCI）治疗患者中对对比剂肾病（contrast induced nephropathy，CIN）的影响。方法：在PubMed、The Cochrane library、维普、知网、万方数据库中搜索从建库到2014年8月的与ACEI/ARB和对比剂肾病相关的文献。根据纳入/排除标准选择文献，评价纳入文献的质量，提取资料采用Stata 11.0软件进行数据Meta数据分析，采用Begg’s法和Egger’s法评估发表偏倚。结果：11项随机对照研究纳入分析，在接受冠脉造影或介入治疗的患者中，与对照组相比，术前使用ACEI/ARB不增加CIN的发生风险，差异无统计学意义（RR=0.78，95%CI＝0.53~1.15，P=0.22）。亚组分析显示，治疗时间≥2周组（RR=0.78，95%CI= 0.37~1.62，P=0.50）和＜2周组（RR=0.79，95%CI＝0.50~1.24，P=0.30）均不影响CIN的发生风险。但ACEI/ARB的使用明显降低术后72 h时CIN的发生风险（RR=0.44，95%CI＝0.23~0.87，P=0.02）；在平均造影剂用量≤150 ml组，CIN的风险也明显降低（RR=0.57，95%CI＝0.33~0.99，P=0.046）。结论：目前尚无证据表明经皮冠状动脉介入诊疗术前使用ACEI/ARB会增加术后CIN的风险。

Abstract:

Objective：To evaluate the effect of angiotensin enzyme inhibitors（ACEI） and angiotensin receptor blockers（ARB） therapy on contrast-induced nephropathy（CIN） in patients undergoing coronary angiogram（CAG） or percutaneous coronary intervention （PCI）. Methods：Search was conducted in PubMed，The Cochrane library，VIP，CNKI and Wanfang data for literatures about ACEI or ARB and CIN up to August 2014. According to the inclusion and exclusion criteria，articles were screened and data were extracted and quality of included studies was evaluated. Mata analysis was conducted by using Stata 11.0 software. Moreover，Begg’s and Egger’s regression were used to assess the publication bias of included articles. Results：Eleven studies were included. Among the patients un－dergoing PCI or CAG，the usage of ACEI/ARB before those operations did not increase the risk of CIN compared with that of control group，and there is no significant difference（RR=0.78；95%CI＝0.53 to 1.15，P=0.22）. In subgroup analysis，subgroups underwent ACEI/ARB treatment for at least 2 weeks（RR=0.78，95%CI＝0.37 to 1.62，P=0.50） and less than 2 weeks（RR=0.79，95%CI=0.50 to 1.24，P=0.30） had no influence on the incidence of CIN. The risk of CIN at 72 h after coronary intervention therapy was decreased（RR=0.23，95%CI=0.23 to 0.87，P=0.02） and the subgroup with contrast agent≤150ml showed a decreasing incidence of CIN（RR=0.57，95%CI=0.33 to 0.99，P=0.046）. Conclusion：There is no evi－dence to suggest that use of ACEI/ARB will increase the risk of CIN in patients undergoing PCI/CAG at present.