背景： 旨在抑制肾素-血管紧张素系统(RAS)的药物已被广泛用于防止糖尿病患者的心血管和肾脏并发症，但是比较其临床效果的数据十分有限。我们的目的是比较各类RAS阻滞剂针对成人糖尿病患者心血管和肾脏预后结果所带来的效果。

1. 成人糖尿病患者肾素-血管紧张素系统阻滞治疗心血管和肾脏预后结果：运用网络统合分析方法的系统性评
估
摘要
背景：
旨在抑制肾素-血管紧张素系统(RAS)的药物已被广泛用于防止糖尿病患者的心血管和肾脏并发症，但是比较其临床效果的数据十分有限。我
们的目的是比较各类RAS阻滞剂针对成人糖尿病患者心血管和肾脏预后结果所带来的效果。
研究方法和结果：
通过PubMed/MEDLINE和Cochrane系统评估数据库（2004年1月1日至2014年7月17日）的电子检索对合格试验进行了确定。相关的干预为血
管紧张素转换酶（ACE）抑制剂、血管紧张素受体阻滞剂（ARB）和直接肾素（DR）抑制剂。主要终点为心血管病死亡率、心肌梗塞及中风
——单独和作为复合终点、主要心血管预后结果和末期肾病[ESRD]、血清肌酸酐加倍以及全因死亡率——单独和作为复合终点、肾病进展。
次要终点为心绞痛和心力衰竭入院。 总计71个试验（103,120名参与者），共14种不同的方案，使用网络统合分析方法汇总。与ACE抑制剂
相比，在单一疗法和/或组合疗法中使用的其他RAS阻滞剂与主要心血管预后结果无相关显著降低：ARB（优势率[OR] 1.02；95％可信区间
[CrI] 0.90-1.18），ACE 抑制剂加ARB（0.97；95％ CrI 0.79-1.19），DR抑制剂加ACE抑制剂（1.32；95％ CrI 0.96-1.81）以及DR抑制剂加ARB
（1.00；95％ CrI 0.73-1.38）。对于肾病进展的风险，在ACE抑制剂和其余每种疗法之间未检测到显著差异：ARB（OR 1.10；95％ CrI 0.90-
1.40），ACE抑制剂加ARB（0.97；95％ CrI 0.72-1.29 ），DR抑制剂加ACE抑制剂（0.99；95％ CrI 0.65-1.57）以及DR抑制剂加ARB（1.18；95
％ CrI 0.78-1.84)。

2. 对于全因死亡率、心血管病死亡率、心肌梗塞、中风、心绞痛、心力衰竭入院、ESRD或血清肌酸酐加倍，ACE抑制剂和ARB之间未出
现显著差异。研究结果受所纳入研究的临床和方法学异质性的限制。在中风和心绞痛的网络统合分析中发现了潜在的不一致，限制了
这些单一终点的研究结果的结论性。
结论：
在成人糖尿病患者中，对不同RAS阻滞剂的比较显示，ACE抑制剂和ARB对主要心血管和肾脏预后结果具有相似效果。与单一疗法相比，
ACE抑制剂和ARB的组合未能对主要结果提供显著益处。临床医生应在开始治疗前与个体糖尿病患者讨论益处、费用和潜在危害之间
的平衡点。
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我们是医学图书馆馆员，我们正在进行一项探索非英语医学研究文章全球知名度的实验。
本摘要的翻译由经认证的翻译人员完成。完整开放获取文章的PubMed引用和链接可在这里
找到 https://www.ncbi.nlm.nih.gov/pubmed/26954482。 请在下面输入您对本项
目及译文质量的意见（如果您是母语人士）。
- 科罗拉多大学健康科学图书馆，Lilian Hoffecker 和 Dana Abbey。

3. Cardiovascular and Renal Outcomes of Renin-Angiotensin System Blockade in Adult Patients with Diabetes Mellitus:
A Systematic Review with Network Meta-Analyses
Abstract
BACKGROUND:
Medications aimed at inhibiting the renin-angiotensin system (RAS) have been used extensively for preventing cardiovascular and renal complications in
patients with diabetes, but data that compare their clinical effectiveness are limited. We aimed to compare the effects of classes of RAS blockers on
cardiovascular and renal outcomes in adults with diabetes.
METHODS AND FINDINGS:
Eligible trials were identified by electronic searches in PubMed/MEDLINE and the Cochrane Database of Systematic Reviews (1 January 2004 to 17 July
2014). Interventions of interest were angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), and direct renin (DR)
inhibitors. The primary endpoints were cardiovascular mortality, myocardial infarction, and stroke-singly and as a composite endpoint, major
cardiovascular outcome-and end-stage renal disease [ESRD], doubling of serum creatinine, and all-cause mortality-singly and as a composite endpoint,
progression of renal disease. Secondary endpoints were angina pectoris and hospitalization for heart failure. In all, 71 trials (103,120 participants), with a
total of 14 different regimens, were pooled using network meta-analyses. When compared with ACE inhibitor, no other RAS blocker used in
monotherapy and/or combination was associated with a significant reduction in major cardiovascular outcomes: ARB (odds ratio [OR] 1.02; 95% credible
interval [CrI] 0.90-1.18), ACE inhibitor plus ARB (0.97; 95% CrI 0.79-1.19), DR inhibitor plus ACE inhibitor (1.32; 95% CrI 0.96-1.81), and DR inhibitor plus
ARB (1.00; 95% CrI 0.73-1.38). For the risk of progression of renal disease, no significant differences were detected between ACE inhibitor and each of
the remaining therapies: ARB (OR 1.10; 95% CrI 0.90-1.40), ACE inhibitor plus ARB (0.97; 95% CrI 0.72-1.29), DR inhibitor plus ACE inhibitor (0.99; 95%
CrI 0.65-1.57), and DR inhibitor plus ARB (1.18; 95% CrI 0.78-1.84).

4. No significant differences were showed between ACE inhibitors and ARBs with respect to all-cause mortality, cardiovascular mortality, myocardial
infarction, stroke, angina pectoris, hospitalization for heart failure, ESRD, or doubling serum creatinine. Findings were limited by the clinical and
methodological heterogeneity of the included studies. Potential inconsistency was identified in network meta-analyses of stroke and angina pectoris,
limiting the conclusiveness of findings for these single endpoints.
CONCLUSIONS:
In adults with diabetes, comparisons of different RAS blockers showed similar effects of ACE inhibitors and ARBs on major cardiovascular and renal
outcomes. Compared with monotherapies, the combination of an ACE inhibitor and an ARB failed to provide significant benefits on major outcomes.
Clinicians should discuss the balance between benefits, costs, and potential harms with individual diabetes patients before starting treatment.
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We are medical librarians conducting an experiment to understand the global visibility of non-English medical research articles. The translation for this
abstract was performed by a certified translator. The PubMed citation and link to the whole open access article can be found here
https://www.ncbi.nlm.nih.gov/pubmed/26954482. Please feel free to add your comments below on the project and, if you are a native-speaker, on
the quality of the translation.
--Lilian Hoffecker and Dana Abbey, Health Sciences Library, University of Colorado.