碳酸镧治疗终末期肾脏病高磷血症的Meta分析

A Meta- analysis of lanthanum carbonate for hyperphosphatemia in end- stage renal disease

目的系统评价碳酸镧治疗终末期肾脏病（ESRD）高磷血症的有效性及安全性。方法通过计算机检索Cochrane图书馆、MEDLINE、EMBASE、CNKI、万方数据库，文献检索起止时间为1996年1月至2011年12月。收集碳酸镧治疗ESRD高磷血症的随机对照试验（RCT），应用RevMan5．1软件对数据进行Meta分析。结果共纳入6篇文献，12个RCT，包括1688例患者。Meta分析结果显示，有效性分析：碳酸镧组血磷达标率与碳酸钙组相似[RR=1．00，95％CI（0．92～1．09），P=0．97]，高于安慰剂组[RR=4．69，95％CI（2．63～8．39），P〈O．01]（剂量≤1500mg）及[RR=18．92，95％CI（7．42～48．22），P〈0．01]（剂量〉1500mg）；碳酸镧组血钙磷乘积降低幅度与碳酸钙组相似[MD=-0．91，95％CI（-7．18—5．36），JP=0．781，大于安慰剂组[MD=-10．50，95％CI（-15．89—-5．10），P〈0．011。安全性分析：碳酸镧组高钙血症发生率低于碳酸钙组[RR=0．06，95％CI（0．01～0．72），P=0．03]。常见消化道不良反应中，碳酸镧组恶心【RR=1．80，95％CI（0．70—4．64），P=0．22]、呕吐[RR=3．94，95％CI（0．45—34．38），P=0．22]、便秘[RR=0．82，95％CI（0．49—1．37），P=0．45]发生率与碳酸钙组相似，与安慰剂相比，恶心[RR=1．55，95％Ct（0．50—4．78），P=0．44]、呕吐[RR=2．07，95％CI（0．38—11．30），P=0．40]发生率相似，便秘[RR=0．19，95％CI（0．06—0．59），P〈0．01]发生率低。结论应用碳酸镧治疗ESRD高磷血症的有效性与碳酸钙相似；与碳酸钙治疗组相比，碳酸镧治疗组高钙血症发生率较低，恶心、呕吐、便秘等常见消化道不良反应发生率相似。

Objective To assess the efficacy and safety of lanthanum carbonate in treatment of hyperphosphatemia in end-stage renal disease （ESRD）. Methods Randomized controlled trails of lanthanum carbonate in treatment of hyperphosphatemia in ESRD patients were searched in the database of MEDLINE,Cochrane Central Register of Controlled Trials, EMBASE, CNKI, Wanfang database. Data extracted from the literatures were analyzed with the Cochrane Collaboration＇ s RevMan 5.1 software. Results Lanthanum carbonate group was similar with calcium carbonate group in treating hyperphosphatemia[RR = 1.00, 95 % CI （0.92-1.09）, P = 0.97], and more effective than placebo [RR = 4.69, 95% CI （2.63 -8.39）, P 〈 0.01] （intervention dose~〈1500 mg） and [RR = 18.92, 95% CI （7.42-48.22）, P 〈 0.01] （intervention dose 〉 1500 mg）. In comparison with calcium carbonate group, the incidence of hypercalcinemia of lanthanum carbonate group was lower [RR = 0.06, 95 % CI （0.01-0.72）, P = 0.03],while the incidence of nausea [RR = 1.80, 95% CI （0.70-4.64）, P = 0.22], vomiting [RR = 3.94,95 % CI （0.45 - 34.38）, P = 0.22] and constipation [RR = 0.82, 95 % CI （0.49 - 1.37）, P = 0.45] were similar. The incidence of nausea and vomiting of lanthanum carbonate group were similar with placebo, with lower incidence of constipation [RR = 0.19, 95 % CI （0.06-0.59）, P 〈 0.01]. Conclusions The efficacy of lanthanum carbonate in treating hyperphosphatemia is similar with calcium carbonate. The incidence of hypercalcinemia of lanthanum carbonate is lower than that of calcium carbonate, and the incidence of gastrointestinal adverse effect such as nausea, vomiting and constipation are sinailar with calcium carbonate.