中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2015年
36期
2969-2975
,共7页
贺磊%林梅%赵天涯%李梦思%高苹
賀磊%林梅%趙天涯%李夢思%高蘋
하뢰%림매%조천애%리몽사%고평
骨化三醇%肾透析%治疗结果%安全性%Meta分析
骨化三醇%腎透析%治療結果%安全性%Meta分析
골화삼순%신투석%치료결과%안전성%Meta분석
Calcitriol%Renal dialysis%Treatment outcome%Safety%Meta-analysis
目的 评价活性维生素D3治疗维持性血液透析(MHD)患者的有效性和安全性.方法 计算机检索PubMed、Embase、谷歌学术、中国知网、维普网、万方数据库、中国生物医学文献数据库(CBM)中关于活性维生素D3治疗MHD患者的随机对照试验(RCT),同时追索纳入文献的参考文献.检索时限均从建库至2014年11月.由2名研究者独立地对符合纳入标准的RCT研究进行筛选、质量评价和资料提取,采用RevMan 5.0软件对符合标准的RCT研究进行荟萃分析.结果 共纳入10个RCT研究.疗效结局指标的分析结果显示:治疗组与对照组比较,在升高血清白蛋白(ALB)及降低甲状旁腺激素(PTH)、碱性磷酸酶(ALP)、C-反应蛋白(CRP)及白细胞介素-6(IL-6)等方面差异均有统计学意义[标准均数差或加权均数差(95％ CI)分别为0.47(0.06,0.88)、-2.49(-3.96,-1.02)、-50.55(-83.91,-17.19)、-1.53(-1.93,-1.12)、-4.71(-7.48,-1.94)].安全性方面结局指标分析结果显示:治疗组与对照组比较,高磷血症、不良事件发生率及病死率差异无统计学意义[RR(95％ CI)分别为1.31 (0.96,1.79)、0.85(0.55,1.32)、1.49(0.80,2.74)],但在升高血钙及钙磷乘积方面两组比较差异有统计学意义[RR(95％ CI)分别为2.10 (1.18,3.75)、3.65(1.45,9.17)].结论 活性维生素D3治疗MHD患者继发性甲状旁腺功能亢进、肾性骨病及改善营养不良-炎症状况等有一定疗效,不良反应发生率低,安全性较高,但在使用过程中需谨防钙磷代谢紊乱.
目的 評價活性維生素D3治療維持性血液透析(MHD)患者的有效性和安全性.方法 計算機檢索PubMed、Embase、穀歌學術、中國知網、維普網、萬方數據庫、中國生物醫學文獻數據庫(CBM)中關于活性維生素D3治療MHD患者的隨機對照試驗(RCT),同時追索納入文獻的參攷文獻.檢索時限均從建庫至2014年11月.由2名研究者獨立地對符閤納入標準的RCT研究進行篩選、質量評價和資料提取,採用RevMan 5.0軟件對符閤標準的RCT研究進行薈萃分析.結果 共納入10箇RCT研究.療效結跼指標的分析結果顯示:治療組與對照組比較,在升高血清白蛋白(ALB)及降低甲狀徬腺激素(PTH)、堿性燐痠酶(ALP)、C-反應蛋白(CRP)及白細胞介素-6(IL-6)等方麵差異均有統計學意義[標準均數差或加權均數差(95％ CI)分彆為0.47(0.06,0.88)、-2.49(-3.96,-1.02)、-50.55(-83.91,-17.19)、-1.53(-1.93,-1.12)、-4.71(-7.48,-1.94)].安全性方麵結跼指標分析結果顯示:治療組與對照組比較,高燐血癥、不良事件髮生率及病死率差異無統計學意義[RR(95％ CI)分彆為1.31 (0.96,1.79)、0.85(0.55,1.32)、1.49(0.80,2.74)],但在升高血鈣及鈣燐乘積方麵兩組比較差異有統計學意義[RR(95％ CI)分彆為2.10 (1.18,3.75)、3.65(1.45,9.17)].結論 活性維生素D3治療MHD患者繼髮性甲狀徬腺功能亢進、腎性骨病及改善營養不良-炎癥狀況等有一定療效,不良反應髮生率低,安全性較高,但在使用過程中需謹防鈣燐代謝紊亂.
목적 평개활성유생소D3치료유지성혈액투석(MHD)환자적유효성화안전성.방법 계산궤검색PubMed、Embase、곡가학술、중국지망、유보망、만방수거고、중국생물의학문헌수거고(CBM)중관우활성유생소D3치료MHD환자적수궤대조시험(RCT),동시추색납입문헌적삼고문헌.검색시한균종건고지2014년11월.유2명연구자독입지대부합납입표준적RCT연구진행사선、질량평개화자료제취,채용RevMan 5.0연건대부합표준적RCT연구진행회췌분석.결과 공납입10개RCT연구.료효결국지표적분석결과현시:치료조여대조조비교,재승고혈청백단백(ALB)급강저갑상방선격소(PTH)、감성린산매(ALP)、C-반응단백(CRP)급백세포개소-6(IL-6)등방면차이균유통계학의의[표준균수차혹가권균수차(95％ CI)분별위0.47(0.06,0.88)、-2.49(-3.96,-1.02)、-50.55(-83.91,-17.19)、-1.53(-1.93,-1.12)、-4.71(-7.48,-1.94)].안전성방면결국지표분석결과현시:치료조여대조조비교,고린혈증、불량사건발생솔급병사솔차이무통계학의의[RR(95％ CI)분별위1.31 (0.96,1.79)、0.85(0.55,1.32)、1.49(0.80,2.74)],단재승고혈개급개린승적방면량조비교차이유통계학의의[RR(95％ CI)분별위2.10 (1.18,3.75)、3.65(1.45,9.17)].결론 활성유생소D3치료MHD환자계발성갑상방선공능항진、신성골병급개선영양불량-염증상황등유일정료효,불량반응발생솔저,안전성교고,단재사용과정중수근방개린대사문란.
Objective To evaluate the efficacy and safety of active vitamin D3 treatment in maintenance hemodialysis patients (MHD).Methods We conducted a comprehensive search of the following databases:PubMed,Embase,Google scholar,CNKI,VIP,Wanfang data and CBM,to identify randomized controlled trials (RCTs) of active vitamin D3 supplementation in MHD patients up to November 2014.Meanwhile,we manually searched the reference lists of identified studies.The selection of studies,assessment of methodological quality and data extraction were performed independently by two researchers.Statistical analyses were performed using RevMan software,version 5.0.Results A total of 10 trials were included.There was a significant improvement in serum albumin(ALB) and an associated decline in PTH,alkaline phosphatase(ALP),C-reactive protein(CRP) and interleukin-6(IL-6) in active vitamin D3-treated group (standardized mean difference(SMD) or weighted mean difference(95％ CI):0.47 (0.06,0.88),-2.49(-3.96,-1.02),-50.55(-83.91,-17.19),-1.53(-1.93,-1.12) and-4.71 (-7.48,-1.94),respectively).There was no statistical difference in the incidence of hyperphosphatemia,adverse events and mortality between the treatment and control group(RR(95％ CI):1.31 (0.96,1.79),0.85 (0.55,1.32),1.49 (0.80,2.74),respectively).But there was a significant increase in serum calcium and calcium-phosphorus product in treatment group (RR(95％ CI):2.10 (1.18,3.75) and 3.65 (1.45,9.17),respectively).Conclusions Currently available evidence suggests that active vitamin D3 is effective in treating secondary hyperparathyroidism,renal osteodystrophy,and improving malnutrition and microinflammation in MHD patients,without obvious adverse events.However,the occurrence of calcium and phosphate abnormalities should be closely monitored.
