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目的:系统评价ACEIs和ARBs对肾移植受者血红蛋白浓度的影响。方法:计算机检索Medline、EMBase、Cochrane CENTRAL、中国生物医学数据库(CBM)、中国期刊全文数据库(CNKI)、中文科技期刊全文数据库(VIP)和万方数据库,检索截止至2016年7月,纳入肾移植受者接受ACEIs或ARBs治疗与安慰剂或空白对照的随机对照试验(RCTs),评价纳入RCTs的偏倚风险,对同质性结果进行Meta分析,并评价结果的GRADE证据质量等级。结果:共纳入10个RCTs,受试者1503例。Meta分析结果显示随访3月、6月、12月及12月以上,ACEIs或ARBs组血红蛋白浓度均低于安慰剂或空白对照组,MD、95%CI和P值分别为:SMD=-1.50,95%CI(-2.10,-0.90);SMD=-0.40,95%CI(-0.77,-0.02),P=0.04;SMD=-0.79,95%CI(-1.20,-0.38),P=0.000 1;SMD=-0.72,95%CI(-0.84,-0.60),P<0.000 01。4个结果的GRADE证据质量等级分别为:中、低、低、中等质量。结论:基于当前证据,RAS抑制剂可降低肾移植受者的血红蛋白浓度。
Objective: To systematically evaluate the effect of ACEIs and ARBs on hemoglobin concentration in renal transplant recipients. METHODS: Medline, EMBase, Cochrane CENTRAL, CBM, CNKI, VIP and Wanfang database were searched by computer. The data were collected by the end of July 2016, The transplant recipients received randomized controlled trials (RCTs) of ACEIs or ARBs for treatment with placebo or placebo, assessing the risk of bias in inclusion of RCTs, performing meta-analyzes of homogeneity results, and evaluating the GRADE evidence of quality of the results. Results: A total of 10 RCTs were enrolled and 1503 subjects were included. Meta-analysis showed that hemoglobin concentrations in ACEIs or ARBs group were lower than placebo or blank control group at follow-up of 3 months, 6 months, 12 months and 12 months. The MD, 95% CI and P values were respectively SMD = -1.50, 95% CI (-1.20, -0.38), P = 0.000 (P = 0.000); 95% CI (-2.10, -0.90); SMD = -0.40, 95% CI 1; SMD = -0.72, 95% CI (-0.84, -0.60), P <0.000. The quality of the GRADE evidence for the 0.4 results is medium, low, low, and medium. Conclusion: Based on the current evidence, RAS inhibitors reduce the hemoglobin concentration in kidney transplant recipients.