Meta分析:普罗布考对对比剂急性肾损伤的影响

Effects of probucol on contrast-induced acute kidney injury:A meta-analysis

目的系统评价普罗布考对行冠状动脉造影(CAG)或经皮冠状动脉介入治疗(PCI)对比剂急性肾损伤(CIAKI)的影响,评价其保护作用的强度、特点及不良反应。方法采用Cochrane系统评价的方法,电子检索中文和英文文献数据库,并手工检索相关随机对照试验的参考文献。评价纳入研究的特点和研究质量,提取有效数据,采用RevMan 5.0软件进行Meta分析。结果普罗布考对CIAKI作用的研究共纳入11篇文献,讲述8个随机对照试验,涉及1938例患者。共有7项研究涉及1298例患者,对比了CIAKI的发生情况,总发生率为10.9%(141/1298),CIAKI在普罗布考组发生率为5.7%(37/652),较对照组16.1%(104/646)发生率低(RR 0.37,95%CI 0.26~0.53)。普罗布考组术后血肌酸酐值较对照组低,第1天(WMD-6.76,95%CI-9.33^-4.20)μmol/L,第2天(WMD-16.90,95%CI-22.61^-11.19)μmol/L,第3天(WMD-11.05,95%CI-17.65^-4.45)μmol/L;术后血肌酸酐峰值亦较对照组低[(WMD-14.58,95%CI-19.00^-10.16)μmol/L]。普罗布考组术后尿中肾损伤分子1(KIM-1)较低[WMD-3.64,95%CI-3.72^-3.57)ng/ml],血清胱抑素C(CysC)亦较低。结论术前或术后口服普罗布考对CIAKI有保护作用,可以抑制CAG或PCI术后的血肌酸酐及CysC等肾损伤指标升高,减少约60%的对比剂相关性肾病发生率,无显著不良反应。

Objective Systematic review the effect and side effect of Probucol on contrast-induced acute kidney injury（CIAKI）, and to evaluate the characteristics and strength of the protective effect. Methods Electronic search studies from databases published in English and Chinese before March 2014, and hand searches of relevant randomized controlled trials of references. Features, the quality of research and valid data of included studies were extracted, then using RevMan 5.0 software to conduct a Metaanalysis base on Cochrane systematic review methods. Results A total of 11 literatures described eight randomized controlled trials involving 1938 cases of patients evaluated the effect of Probucal on CIAKI. A total of seven studies involving 1,298 patients, compared the incidence of CIAKI, the total incidence rate was 10.9%（141/1298）, CIAKI incidence was 5.7%（37/652） in the Probucal group and 16.1%（104/646） in the control group（RRthe control group（ 0.37, 95% CI 0.26 ～ 0.53）. Lower postoperative creatinine values was observed in Probucol group, compared with the control group on the fi rst day Weighted Mean Difference（WMD-6.76, 95% CI- 9.33 ～- 4.20） μmol/L, the second day（WMD- 16.90, 95% CI- 22.61 ～- 11.19） μmol/L, the third day（WMD- 11.05, 95% CI- 17.65 ～- 4.45）μmol/L, and lower peak postoperative creatinine than the control group[（WMD- 14.58, 95% CI- 19.00 ～- 10.16）μmol/L]. Probucol group with lower postoperative urinary KIM-1[（WMD- 3.64, 95% CI- 3.72 ～- 3.57） ng/ml], and the serum CysC was also low. Conclusions Preoperative or postoperative oral Probucol has a protective effect on CIAKI, can reduce the rise of postoperative renal injury indicators of coronary angiography or coronary intervention, such as serum creatinine and CysC, and CIAKI can be reduced by about 60%, no signifi cant side effects observed.