中华肾脏病杂志
中華腎髒病雜誌
중화신장병잡지
2015年
1期
30-36
,共7页
卢永新%杨胜淋%李玉敏%粱敏
盧永新%楊勝淋%李玉敏%粱敏
로영신%양성림%리옥민%량민
肾功能衰竭,慢性%肾小球滤过率%蛋白尿%Meta分析%帕立骨化醇
腎功能衰竭,慢性%腎小毬濾過率%蛋白尿%Meta分析%帕立骨化醇
신공능쇠갈,만성%신소구려과솔%단백뇨%Meta분석%파립골화순
Renal failure,chronic%Glomerular filtration rate%Proteinuria%Meta-analysis%Paricalcitol
目的 系统评价帕立骨化醇对非透析慢性肾脏病患者估算肾小球滤过率(eGFR)及尿蛋白的影响.方法 计算机检索PubMed、Cochrane、Embase、万方、CNKI、维普等数据库,检索时限均为建库至2014年3月;手工检索美国肾脏病学会、世界肾脏病大会、中华医学会肾脏病学分会年会的会议论文、摘要等.纳入帕立骨化醇对非透析肾脏病患者eGFR及尿蛋白影响的临床随机对照试验研究.由两名评价员独立对纳入的文献进行质量评价和数据提取,用Rev Man 5.2软件进行Meta分析.结果 共纳入7项随机对照试验,共834例患者(其中试验组508例,安慰剂组326例).Meta分析结果显示,与安慰剂组比较,小剂量组(帕立骨化醇＜2 μg/d)对慢性肾脏病患者eGFR的影响差异无统计学意义[标准均数差(SMD)为-0.10,95％CI:-0.28 ～ 0.07,P=0.26];大剂量组(帕立骨化醇2μg/d)eGFR下降差异有统计学意义[SMD=-0.45,95％CI:-0.63-0.27,P＜0.01].与安慰剂组比较,大小剂量组均有降尿蛋白作用[OR(95％CI):2.09(1.52～2.58),P＜0.01],大小剂量组组间降尿蛋白作用的差异无统计学意义[OR(95％CI):1.09(0.62～ 1.91),P=0.77].与安慰剂组比较,小剂量组[OR (95％CI):0.93 (0.57～1.52),P=0.76]和大剂量组[0R(95％CI):2.08 (0.70～ 6.18),P=0.19]均未显著增加不良事件发生率.结论 小剂量帕立骨化醇可减少非透析慢性肾脏病患者尿蛋白,同时对eGFR无影响.大剂量帕立骨化醇(2μg/d)无进一步减少尿蛋白的疗效,且可能带来eGFR下降风险.
目的 繫統評價帕立骨化醇對非透析慢性腎髒病患者估算腎小毬濾過率(eGFR)及尿蛋白的影響.方法 計算機檢索PubMed、Cochrane、Embase、萬方、CNKI、維普等數據庫,檢索時限均為建庫至2014年3月;手工檢索美國腎髒病學會、世界腎髒病大會、中華醫學會腎髒病學分會年會的會議論文、摘要等.納入帕立骨化醇對非透析腎髒病患者eGFR及尿蛋白影響的臨床隨機對照試驗研究.由兩名評價員獨立對納入的文獻進行質量評價和數據提取,用Rev Man 5.2軟件進行Meta分析.結果 共納入7項隨機對照試驗,共834例患者(其中試驗組508例,安慰劑組326例).Meta分析結果顯示,與安慰劑組比較,小劑量組(帕立骨化醇＜2 μg/d)對慢性腎髒病患者eGFR的影響差異無統計學意義[標準均數差(SMD)為-0.10,95％CI:-0.28 ～ 0.07,P=0.26];大劑量組(帕立骨化醇2μg/d)eGFR下降差異有統計學意義[SMD=-0.45,95％CI:-0.63-0.27,P＜0.01].與安慰劑組比較,大小劑量組均有降尿蛋白作用[OR(95％CI):2.09(1.52～2.58),P＜0.01],大小劑量組組間降尿蛋白作用的差異無統計學意義[OR(95％CI):1.09(0.62～ 1.91),P=0.77].與安慰劑組比較,小劑量組[OR (95％CI):0.93 (0.57～1.52),P=0.76]和大劑量組[0R(95％CI):2.08 (0.70～ 6.18),P=0.19]均未顯著增加不良事件髮生率.結論 小劑量帕立骨化醇可減少非透析慢性腎髒病患者尿蛋白,同時對eGFR無影響.大劑量帕立骨化醇(2μg/d)無進一步減少尿蛋白的療效,且可能帶來eGFR下降風險.
목적 계통평개파립골화순대비투석만성신장병환자고산신소구려과솔(eGFR)급뇨단백적영향.방법 계산궤검색PubMed、Cochrane、Embase、만방、CNKI、유보등수거고,검색시한균위건고지2014년3월;수공검색미국신장병학회、세계신장병대회、중화의학회신장병학분회년회적회의논문、적요등.납입파립골화순대비투석신장병환자eGFR급뇨단백영향적림상수궤대조시험연구.유량명평개원독립대납입적문헌진행질량평개화수거제취,용Rev Man 5.2연건진행Meta분석.결과 공납입7항수궤대조시험,공834례환자(기중시험조508례,안위제조326례).Meta분석결과현시,여안위제조비교,소제량조(파립골화순＜2 μg/d)대만성신장병환자eGFR적영향차이무통계학의의[표준균수차(SMD)위-0.10,95％CI:-0.28 ～ 0.07,P=0.26];대제량조(파립골화순2μg/d)eGFR하강차이유통계학의의[SMD=-0.45,95％CI:-0.63-0.27,P＜0.01].여안위제조비교,대소제량조균유강뇨단백작용[OR(95％CI):2.09(1.52～2.58),P＜0.01],대소제량조조간강뇨단백작용적차이무통계학의의[OR(95％CI):1.09(0.62～ 1.91),P=0.77].여안위제조비교,소제량조[OR (95％CI):0.93 (0.57～1.52),P=0.76]화대제량조[0R(95％CI):2.08 (0.70～ 6.18),P=0.19]균미현저증가불량사건발생솔.결론 소제량파립골화순가감소비투석만성신장병환자뇨단백,동시대eGFR무영향.대제량파립골화순(2μg/d)무진일보감소뇨단백적료효,차가능대래eGFR하강풍험.
Objective To systematic evaluate the efficacy of paricalcitol on estimated glomerular filtration rate (eGFR) and proteinuria in non-dialysis chronic kidney disease (CKD) patients.Methods According to the collaborative search strategy,PubMed,the clinical control test database of Cochrane Library,Embase,Chinese Wanfang database,CNKI,VIP database (form the date of database establishment to March 2014) were searched.Published and unpublished literature,abstracts in academic meetings (ASN,WCN,CSN) were also searched by hand.The randomized controlled trials (RCTs) about the efficacy paricalcitol on eGFR and proteinuria in non-dialysis CKD patients were selected.Review Manager Software 5.2 was used for statistical analysis.Results Seven RCTs with a total of 834 patients were included (508 in experimental group,326 in placebo group).No statistical difference of the efficacy on eGFR[SMD=-0.10,95％ CI:(-0.28-0.07),P=0.26] between lower dose paricalcitol (＜ 2 μg/d) group and placebo group,while higher dose (2 μg/d) group reduced eGFR significantly [SMD=-0.45,95％ CI:(-0.63--0.27),P ＜ 0.01].Compared with placebo,paricalcitol reduced proteinuria significantly [OR(95％C1):2.09(1.52-2.58),P ＜ 0.01],and there was no difference between different dose groups [OR(95％CI):1.09(0.62-1.91),P=0.77].Lower dose group [OR(95％C1):0.93(0.57-1.52),P=0.76] and higher dose group [OR(95％ CI):2.08(0.70-6.18),P=0.19] did not significantly increase the risk of adverse events.Conclusions Lower dose paricalcitol (＜ 2 μg/d)has no effect on eGFR in non-dialysis CKD patients meanwhile reduces proteinuria.The higher dose (2μg/d) may reduce eGFR without farther reduction in proteinuria.
