CAJ | 학술논문

目的：综合分析西那卡塞治疗慢性肾脏疾病合并继发性甲状旁腺功能亢进症(second-ary hyperparathyroidism,SHPT)患者的安全性与有效性。方法在 Cochrane Central Register of Controlled Trials,Cochrane Database of Systematic Reviews,Embase,Medline四个数据库中检索应用西那卡塞治疗慢性肾脏疾病合并 SHPT 患者的随机对照分析。其纳入标准为慢性肾脏疾病合并SHPT且正在行透析治疗的患者,年龄≥18岁；治疗组接受西那卡塞加常规治疗,对照组接受安慰剂加常规治疗或只接受常规治疗,常规治疗包括维生素D类似物和(或)磷结合剂。结果共检索出14篇满足纳入标准的文献。结果显示西那卡塞明显降低了 SHPT患者血甲状旁腺素(parathyroid hor-mone,PTH)水平[MD,-285.89 ng/L (95% CI：-341.27,-230.51)]、血钙浓度[MD,-0.21 mmol/L(95% CI：-0.24,-0.18)]、血磷浓度[MD,-0.13 mmol/L(95% CI：-0.17,-0.08)]以及钙磷乘积的水平[MD,-8.99(95% CI：-10.37,-7.61)],但是西那卡塞对骨代谢方面作用不确定,也并不能降低患者的全因病死率[RR 0.97(95% CI：0.89,1.05)]。与对照组比较,使用西那卡塞治疗的患者更容易发生低钙血症、恶心、呕吐、上呼吸道感染。结论西那卡塞治疗能有效的改善SHPT患者血生化指标,但并没有有效降低患者的全因病死率。
목적：종합분석서나잡새치료만성신장질병합병계발성갑상방선공능항진증(second-ary hyperparathyroidism,SHPT)환자적안전성여유효성。방법재 Cochrane Central Register of Controlled Trials,Cochrane Database of Systematic Reviews,Embase,Medline사개수거고중검색응용서나잡새치료만성신장질병합병 SHPT 환자적수궤대조분석。기납입표준위만성신장질병합병SHPT차정재행투석치료적환자,년령≥18세；치료조접수서나잡새가상규치료,대조조접수안위제가상규치료혹지접수상규치료,상규치료포괄유생소D유사물화(혹)린결합제。결과공검색출14편만족납입표준적문헌。결과현시서나잡새명현강저료 SHPT환자혈갑상방선소(parathyroid hor-mone,PTH)수평[MD,-285.89 ng/L (95% CI：-341.27,-230.51)]、혈개농도[MD,-0.21 mmol/L(95% CI：-0.24,-0.18)]、혈린농도[MD,-0.13 mmol/L(95% CI：-0.17,-0.08)]이급개린승적적수평[MD,-8.99(95% CI：-10.37,-7.61)],단시서나잡새대골대사방면작용불학정,야병불능강저환자적전인병사솔[RR 0.97(95% CI：0.89,1.05)]。여대조조비교,사용서나잡새치료적환자경용역발생저개혈증、악심、구토、상호흡도감염。결론서나잡새치료능유효적개선SHPT환자혈생화지표,단병몰유유효강저환자적전인병사솔。
Objective To evaluate the safety and efficacy of cinacalcet in treating secondary hy-perparathyroidism in patients with chronic kidney disease (CKD).Methods Cochrane Central Regis-ter of Controlled Trials,Cochrane Database of Systematic Reviews,Embase and Medline were searched for randomized controlled trials (RCTs)of using cinacalcet to treat secondary hyperparathyroidism in patients with CKD.The patients in treatment group were given therapy of cinacalcet plus conventional therapy,including vitamin D analogs and(or)phosphate binders,and those in control group got therapy of placebo with conventional therapy or only conventional therapy.Results Fourteen studies were i-dentified.The results showed that cinacalcet significantly reduced PTH levels [MD -285.89 pg/mL, (95% CI -341.27 to -230.51)],serum calcium levels [MD -0.21 mmol/L,(95% CI -0.24 to-0.18)],serum phosphorus levels [MD -0.13 mmol/L,(95% CI -0.17 to -0.08)]and calcium-phosphorus product [MD -8.99 (95% CI -10.37 to -7.61)]as compared with control group.But cinacalcet had an uncertain effect on bone metabolism,and did not reduce the overall mortality [RR 0.97,(95% CI 0.89 to 1.05)]in patients.Compared with control group,patients treated with cina-calcet got more hypocalcaemia,nausea,emesis and upper respiratory infection.Conclusions Treatment of cinacalcet could effectively improve serum biochemical indexes in CKD patients with secondary hy-perparathyroidism,but did not reduce the overall mortality.