孕早期使用ACEI/ARB与不良妊娠结局的Meta分析  

Adverse pregnancy outcomes associated with first-trimester exposure to ACEI or ARB:a meta-analysis

作　　者：张崇 潘洁 张骏 程玉洁 Zhang Chong;Pan Jie;Zhang Jun;Cheng Yujie(Department of Pharmacy,Xiangyang No.1 People′s Hospital,Hubei University of Medicine,Xiangyang 441000,China)

机构地区：[1]湖北医药学院附属襄阳市第一人民医院药学部,湖北襄阳441000

出　　处：《实用药物与临床》2022年第11期991-996,共6页Practical Pharmacy and Clinical Remedies

摘　　要：目的 探讨孕早期使用血管紧张素转化酶抑制剂(Angiotensin converting enzyme inhibitors, ACEI)或血管紧张素Ⅱ受体阻滞剂(AngiotensinⅡreceptor blocker, ARB)是否增加不良妊娠结局风险。方法 通过检索PubMed、Embase、Cochrane Library数据库,收集孕早期使用ACEI或ARB与先天性畸形关系的相关研究,采用RevMan 5.4.1软件进行分析。结果 孕早期使用ACEI/ARB显著增加胎儿先天性畸形风险(OR=1.85,95%CI:1.65~2.06,P<0.01),其中心血管畸形风险升高明显(OR=3.05,95%CI:2.61~3.57,P<0.01);同时,自发性流产和终止妊娠的几率也明显升高。与使用其他降压药的人群相比,ACEI/ARB组的畸形风险升高(OR=1.44,95%CI:1.06~1.94,P<0.05)。剔除糖尿病的影响后,ACEI/ARB组畸形风险升高,差异无统计学意义(OR=1.76,95%CI:0.97~3.20,P>0.05)。结论 孕早期使用ACEIs/ARBs增加先天性畸形风险,但这种风险可能与相关人群糖尿病的患病率较高有关。Objective To investigate whether the angiotensin-converting enzyme inhibitors(ACEI)or angiotensin Ⅱ receptor blockers(ARB)during first trimester increase the risk of adverse pregnancy outcomes.Methods By searching PubMed, Embase and Cochrane Library databases, relevant studies on the relationship between the use of ACEI or ARB and congenital malformation during first-trimester were collected and analyzed by RevMan 5.4.1 software.Results ACEI/ARB during first trimester significantly increased the risk of fetal congenital malformations(OR=1.85,95%CI:1.65~2.06,P<0.01),and the risk of cardiovascular malformation was increased significantly(OR=3.05,95%CI:2.61~3.57,P<0.01).In addition, the risk of spontaneous miscarriage and termination of pregnancy were also increased more significantly.There was an increased risk of malformation in ACEI/ARB group compared with other antihypertensive agents(OR=1.44,95%CI:1.06~1.94,P<0.05).After eliminating the effect of diabetes, the risk of malformation was slightly increased(OR=1.76,95%CI:0.97~3.20,P>0.05).Conclusion ACEI/ARB during first trimester increases the risk of congenital malformation, which may be associated with a higher prevalence of diabetes in the associated population.

关 键 词：孕早期 血管紧张素转化酶抑制剂 血管紧张素Ⅱ受体阻滞剂 不良妊娠结局 

分 类 号：R714.246[医药卫生—妇产科学]