Angiotensin-converting enzyme inhibitors and progression of nondiabetic renal disease - A meta-analysis of patient-level data
Angiotensin-converting enzyme inhibitors and progression of nondiabetic renal disease - A meta-analysis of patient-level data
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DOI：
10.7326/0003-4819-135-2-200107170-00007
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发表时间：
2001-07-17
影响因子：
39.2
通讯作者：
Levey, AS
中科院分区：
文献类型：
--
作者：
Jafar, TH;Schmid, CH;Levey, AS
目的：观察ACE抑制剂治疗非糖尿病肾病的疗效。数据来源：11项随机对照试验，比较包括ACE抑制剂的降压方案与不含ACE抑制剂的降压方案对主要非糖尿病肾病的疗效。研究选择：从1977年5月（ACE抑制剂被批准用于人体试验）到1997年9月，通过MEDLINE数据库搜索评估ACE抑制剂对人类肾脏疾病影响的英文研究来确定研究。资料提取：对1860例非糖尿病患者资料进行分析。数据综合：平均随访时间为2.2年。患者血管紧张素转化酶抑制剂组更大的意思是降低收缩压和舒张压(4.5毫米汞柱(95% CI, 3.0 - 6.1毫米汞柱))和2.3毫米汞柱(CI, 1.4 - 3.2毫米汞柱),分别)和尿蛋白排泄(0.46 g / d (CI, 0.33 - 0.59 g / d)),调整后患者在基线和研究特点和收缩压的变化和尿蛋白排泄在随访期间,相对风险的ACE抑制剂组0.69 (CI,对于终末期肾脏疾病而言为0.51 - 0.94)，对于基线血清肌酐浓度加倍或终末期肾脏疾病的综合结局而言为0.70 （CI, 0.55 - 0.88）。基线尿蛋白排泄量较大的患者从ACE抑制剂治疗中获益更多（分别为P= 0.03和P= 0.001），但对于基线尿蛋白排泄量小于0.5 g/d的患者是否也受益，数据尚无结论。结论：在减缓非糖尿病肾病进展方面，含ACE抑制剂的降压方案比不含ACE抑制剂的降压方案更有效。除降低血压和尿蛋白排泄外，ACE抑制剂的有益作用是由其他因素介导的，在蛋白尿患者中效果更大。血管紧张素转换抑制剂适用于慢性肾脏疾病和蛋白尿的非糖尿病患者，可能也适用于无蛋白尿的患者。
Purpose: To examine the efficacy of ACE inhibitors for treatment of nondiabetic renal disease.Data Sources: 11 randomized, controlled trials comparing the efficacy of antihypertensive regimens including ACE inhibitors to the efficacy of regimens without ACE inhibitors in predominantly nondiabetic renal disease.Study Selection: studies were identified by searching the MEDLINE database for English-language studies evaluating the effects of ACE inhibitors on renal disease in humans between May 1977 (when ACE inhibitors were approved for trials in humans) and September 1997.Data Extraction: Data on 1860 nondiabetic patients were analyzed.Data Synthesis: Mean duration of follow-up was 2.2 years. Patients in the ACE inhibitor group had a greater mean decrease in systolic and diastolic blood pressure (4.5 mm Hg [95% CI, 3.0 to 6.1 mm Hg]) and 2.3 mm Hg [CI, 1.4 to 3.2 mm Hg], respectively) and urinary protein excretion (0.46 g/d [CI, 0.33 to 0.59 g/d]), After adjustment for patient and study characteristics at baseline and changes in systolic blood pressure and urinary protein excretion during follow-up, relative risks in the ACE inhibitor group were 0.69 (CI, 0.51 to 0.94) for end-stage renal disease and 0.70 (CI, 0.55 to 0.88) far the combined outcome of doubling of the baseline serum creatinine concentration or end-stage renal disease. Patients with greater urinary protein excretion at baseline benefited more from ACE inhibitor therapy (P= 0.03 and P= 0.001, respectively), but the data were inconclusive as to whether the benefit extended to patients with baseline urinary protein excretion less than 0.5 g/d.Conclusion: Antihypertensive regimens that include ACE inhibitors are more effective than regimens without ACE inhibitors in slowing the progression of nondiabetic renal disease. The beneficial effect of ACE inhibitors is mediated by factors in addition to decreasing blood pressure and urinary protein excretion and is greater in patients with proteinuria. Angiotensin-converting inhibitors are indicated for treatment of nondiabetic patients with chronic renal disease and proteinuria and, possibly, those without proteinuria.