前列腺素E_1联合水化预防造影剂肾病疗效和安全性的系统评价

Systematic Review of the Efficacy and Safety of Prostaglandin E_1 Combined with Hydration for the Prevention of Contrast-induced Nephropathy

目的:系统评价前列腺素E1(PGE1)联合水化预防造影剂肾病(CIN)的疗效和安全性,以为临床用药提供循证参考。方法:计算机检索Pub Med、Medline(Ovid)、EMBase(Ovid)、Cochrane图书馆、中文科技期刊全文数据库、中国期刊全文数据库、万方数据库,收集PGE1联合水化预防CIN的随机对照试验(RCT),提取数据和进行方法学质量评价后,采用Rev Man 5.3软件进行Meta分析。结果:共纳入12项RCT,合计1 732例患者。Meta分析结果显示,试验组患者CIN发生率显著低于对照组[RR=0.40,95%CI(0.30,0.53),P<0.001],静脉炎发生率显著高于对照组[RR=10.18,95%CI(1.37,75.67),P=0.02],而肾脏替代治疗需求率与对照组比较差异无统计学意义[RR=0.44,95%CI(0.12,1.61),P=0.21]。结论:采用PGE1联合水化可以有效降低CIN发生率,但临床应注意患者静脉炎的发生。受纳入研究质量和研究样本的限制,该结论有待大样本、高质量的RCT进一步验证。

OBJECTIVE：To systematically evaluate the efficacy and safety of prostaglandin E1 combined with hydration for the prevention of contrast-induced nephropathy（CIN）and provide evidence-based reference for the clinical treatment. METHODS：The Pub Med,Medline（Ovid）,EMbase（Ovid）,Cochrane Library,VIP,CJFD and Wan Fang database were retrieved to collect the randomized controlled trails（RCT）of prostaglandin E1 combined with hydration for the prevention of CIN. After information collection and methodology quality evaluation,the Meta-analysis was performed using Rev Man 5.3 software. RESULTS：12 RCTs involving 1 732 patients were included. The results of Meta-analysis showed that the incidence of CIN in test group was significantly lower than control group[RR=0.40,95% CI（0.30,0.53）,P〈0.001],the incidence of phlebitis was higher than control group [RR=10.18,95%CI（1.37,75.67）,P=0.02] and there was no significant difference in the need rate of renal replacement between test group and control group[RR=0.44,95% CI（0.12,1.61）,P=0.21]. CONCLUSIONS：Intravenous prostaglandin E1 combined with hydration can effectively reduce the incidence of CIN. Occurance of phlebitis should be paid attention to. Due to the limited quality and sample of included studies,it remains to be further verified by high-quality and large-sample RCT.