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利尿剂联合血管紧张素转换酶抑制剂(ACEI)或血管紧张素受体拮抗剂(ARB)加用非甾体类抗炎药物(NSAID)是否增加急性肾损伤风险值得探讨。该研究采用回顾性队列研究,进行巢式病例对照分析。使用与英国临床实践研究数据链(UK clinical practice research datalink)相关联的统计数据(hospital episodes statistics data-base),评估利尿剂或ACEI或ARB中的一种联合使用NSAID(二联用药)和利尿剂联合ACEI或ARB中的一种加用NSAID(三联用药)与急性肾损伤风险的相关性。研究共纳入使用降压药的患者487372例,经过(5.9±3.4)年随访,确诊急性肾损伤2215例(发病率7/10000人年)。研究结果显示,二联用药与急性肾损伤无关,而三联用药与急性肾损伤相关(RR1.31,95%CI1.12～1.53),进一步研究分析,在最开始治疗的30天内,三联用药与急性肾损伤风险的相关性最高(RR1.82,95%CI1.35～2.46)。结论:利尿剂联合ACEI或ARB中的一种加用NSAID(三联用药)与急性肾损伤相关。
Whether diuretics combined with angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) plus non-steroidal anti-inflammatory drugs (NSAIDs) increases the risk of acute kidney injury should be explored. The study used a retrospective cohort study of nested case-control analyzes. Using a hospital episodes statistics data-base associated with the UK clinical practice research datalink, one of the diuretics or ACEIs or ARBs was evaluated for a combination of NSAIDs and diuresis A combination of ACEI or ARB plus NSAID (Triple Use) in association with the risk of acute kidney injury. A total of 487 372 patients with antihypertensive drugs were enrolled in the study. After a mean follow-up of 5.9 ± 3.4 years, 2215 acute kidney injuries were diagnosed (incidence 7/10000 person-years). The results showed that the combination of two drugs has nothing to do with acute kidney injury, triple therapy and acute kidney injury (RR1.31,95% CI 1.12 ~ 1.53), further study and analysis, within the first 30 days of treatment, triple drug and The highest risk of acute kidney injury was associated (RR 1.82, 95% CI 1.35-2.46). CONCLUSIONS: Diuretics in combination with ACEI or ARB plus NSAID (triple therapy) are associated with acute kidney injury.