肾脏血管重建治疗对动脉粥样硬化性肾动脉狭窄患者临床预后影响的Meta分析-东南大学学报医学版

肾脏血管重建治疗对动脉粥样硬化性肾动脉狭窄患者临床预后影响的Meta分析

单位：1. 东南大学医学院, 江苏南京 210009;
2. 东南大学附属中大医院肾脏病研究所, 江苏南京 210009

分类号：R543.5

出版年·卷·期（页码）：2014·33·第六期（741-746）

摘要：

目的: 系统评价肾脏血管重建治疗与单独药物治疗相比,能否为动脉粥样硬化性肾动脉狭窄(ARAS)患者带来额外的临床获益.方法: 计算机检索Cochrance Library、PubMed等数据库并手工检索入选参考文库中未检索出的文献,全面搜集比较ARAS患者肾脏血管重建治疗联合药物治疗与单独药物治疗的随机对照试验,应用RevMan 5.2和STATA 12.0软件进行统计分析.结果: 肾脏血管重建治疗联合药物治疗与单纯药物治疗相比,两组患者间在全因死亡率(RR=0.92,95%CI为0.77~1.10,P=0.36)、充血性心力衰竭(RR=0.88,95%CI为0.67~1.15,P=0.36)、卒中(RR=0.81,95%CI为0.53~1.23,P=0.33)、肾功能恶化(RR=0.89,95%CI为0.72~1.10,P=0.28)等临床事件的发生上差异无统计学意义.结论: 在药物治疗的基础上,肾脏血管重建治疗似乎并不能为ARAS患者在改善远期预后方面带来额外的获益.药物治疗可能仍是ARAS患者目前主要的治疗手段.

Objective: To systematically evaluate whether renal percutaneous revascularization brings additional clinical benefit in patients with atherosclerotic renal artery stenosis(ARAS) compared to medical therapy alone. Methods: We searched for randomized controlled trial(RCT) that compared renal percutaneous revascularization in addition to medical therapy versus medical therapy alone in ARAS in Cochrance Library and PubMed.Statistical analysis was performed with RevMan 5.2 and STATA 12.0. Results: Compared to medical therapy alone,renal percutaneous revascularization did not significantly change the occurrence rate of all-cause motality(RR=0.92,95%CI 0.77-1.10,P=0.36),congestive heart failure(RR=0.88,95%CI 0.67-1.15,P=0.36),stroke(RR=0.81,95%CI 0.53-1.23,P=0.33),or worsening renal function(RR=0.89,95%CI 0.72-1.10,P=0.28). Conclusion: Renal percutaneous revascularization does not confer additional benefit with respect to the improvement of prognosis when added to medical therapy in patients with atherosclerotic renal artery stenosis.Medical therapy may still be the major choice for these patients.

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