肾素-血管紧张素系统抑制剂对肾移植受者血红蛋白影响的Meta分析

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1 503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。

Effects of RAS inhibitors on hemoglobin in kidney transplant recipients:a Meta analysis

OBJECTIVE To analyze the effects of ACEIs and ARBs on hemoglobin (Hb) in kidney transplant recipients.METHODS Databases of Medline, EMBase, Cochrane CENTRAL, CBM, CNKI, VIP and Wanfang were searched to the date of July 2016 for randomized controlled trials (RCTs) of kidney transplant recipients received ACEIs or ARBs treatment compared with placebo or no treatment. Risk of bias of included RCTs was assessed, homogeneous outcomes meta analyzed and the GRADE degree of each outcome evaluated.RESULTS Ten RCTs with a total of 1503 patients were collected. The meta analysis indicated that the Hb level was lower in the ACEIs or ARBs groups than the placebo or no treatment group after 3months, 6 months, 12 months and even over 12 months, the MD, 95%CI and P value were 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. The GRADE degree of the four outcomes were moderate, low, low and moderate degree.CONCLUSION Based on current evidence, RAS inhibitor can decrease the Hb level.