最新一期的American Journal of Transplantation杂志刊登的一项研究"Treatment of kidney transplant recipients with ACEi/ARB and risk of respiratory tract cancer: a collaborative transplant study report"表明：有吸烟史的肾移植患者应用ACEI/ARB显著增加呼吸道/胸腔内肿瘤风险。
已有荟萃分析显示普通人群应用ARB可能增加恶性肿瘤（尤其是肺癌）的发生率，但目前对于ACEI/ARB的应用是否增加恶性肿瘤风险仍有争论，最近有学者统计了24090例肾移植患者中9079例（38%）应用ACEI/ARB患者的肿瘤发生情况。
结果显示，872例在移植后2-8年发生非皮肤的恶性肿瘤，其中107例为呼吸道或胸腔内肿瘤；与普通人群相比，应用ACEI/ARB的肾移植患者的非皮肤恶性肿瘤的标准化发病率风险比（1.91）与未应用ACEI/ARB的患者（1.81）相近（P=0.42），但应用ACEI/ARB的肾移植患者的呼吸道肿瘤/胸腔内肿瘤的标准化发病率风险比显著高于未应用ACEI/ARB的患者（1.65 vs. 1.09, p = 0.033）；多因素回归分析显示，不吸烟的肾移植患者应用ACEI/ARB与呼吸道/胸腔内肿瘤发生率无显著相关，而有吸烟史的未应用ACEI/ARB肾移植患者的呼吸道/胸腔内肿瘤风险比为2.77（P=0.018），有吸烟史的应用ACEI/ARB肾移植患者的呼吸道/胸腔内肿瘤风险比为7.10（P＜0.001）。
因此，有吸烟史的肾移植患者应用ACEI/ARB显著增加呼吸道/胸腔内肿瘤风险。（生物谷bioon.com）
doi:10.1111/j.1600-6143.2011.03681.x
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Treatment of kidney transplant recipients with ACEi/ARB and risk of respiratory tract cancer: a collaborative transplant study report
Opelz G, Döhler B.
Whether treatment with angiotensin-converting enzyme inhibitors (ACEi) and/or angiotensin receptor blockers (ARB) increases the risk of cancer is controversial. Collaborative transplant study data were analyzed according to whether kidney transplant recipients were treated with ACEi/ARB at year 1. Twenty-four thousand and ninety patients were studied of whom 9079 (38%) patients received ACEi/ARB. There were 872 nonskin malignancies during years 2-8 posttransplant, including 107 respiratory/intrathoracic tumors. The standardized incidence ratio (SIR) for all nonskin malignancies was similar between the ACEi/ARB (1.91) and no ACEi/ARB (1.81) groups (p = 0.42). For respiratory/intrathoracic tumors, however, SIR was significantly higher with ACEi/ARB (1.65 vs. 1.09 for no ACEi/ARB, p = 0.033). Multivariate Cox regression analysis showed that ACEi/ARB treatment was not associated with an increased risk of respiratory/intrathoracic tumors in nonsmokers. In patients with a history of smoking, however, the risk of respiratory/intrathoracic tumors was 2.77 (95% CI 1.19-6.43, p = 0.018) in patients without ACEi/ARB treatment as compared to 7.10 (95% CI 3.27-15.4, p < 0.001) in patients treated with ACEi/ARB. Our data indicate that in kidney transplant recipients, ACEi/ARB treatment is associated with a significant increase in the rate of respiratory/intrathoracic tumors in the subpopulation of patients with a history of smoking.
