【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ACEI/ARB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RevMan5.1对入选试验进行Meta分析。结果:共纳入9项研究,荟萃分析结果如下:(1)ACEI/ARB组患者残余肾功能、24h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<0.000 01)、(WDM=197.66,95%CI140.78~254.54,P<0.000 001)(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=-1.32,95%CI-2.17~-0.47,P=0.002),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但无统计学差异(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。更多还原

【Abstract】 Objective: 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. Results: 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% CI 90. 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.更多还原