加巴喷丁治疗尿毒症患者皮肤瘙痒症的Meta分析

Meta-analysis of GabapentinT reatment of Uremic Pruritus Patients

目的系统评价加巴喷丁治疗尿毒症皮肤瘙痒的有效性及安全性。方法计算机检索MEDLINE、EMbase、the Cochrane Renal Group’s Specialized Register and CENTRAL、CNKI、VIP、Wan Fang Data和CBM数据库,搜集加巴喷丁治疗尿毒症皮肤瘙痒的相关随机对照试验（randomized controlled trial,RCT）。由2位研究者独立进行文献筛选、资料提取和纳入研究的方法学质量评价后,采用Rev Man 5.2软件进行统计分析。结果最终纳入10个RCT,共519例患者。其中英文3篇、中文7篇,随访时间为1~12周。Meta分析结果显示：加巴喷丁治疗尿毒症皮肤瘙痒的效果明显优于安慰剂组/空白对照组和抗组胺药物组[SMD：-4.91,95%CI（-6.96,-2.86）,P〈0.00001]。部分研究还比较了试验前后血红蛋白、甲状旁腺激素、钙、磷等实验室指标均未见明显变化。加巴喷丁组报道了41例,多为轻-中度的恶心、头晕、嗜睡、疲劳,一般在第一次服药一周后症状消失,未报道严重不良反应。对照组（安慰剂组/空白对照组和抗组胺药物组）报道了6例不良反应,多为轻-中度的恶心、头晕,均未作特殊处理。所有研究均未报道死亡病例。结论当前证据显示,短期服用加巴喷丁可以改善尿毒症患者皮肤瘙痒状况,但受纳入研究数量和质量限制,本研究结论尚需开展更多大样本、高质量、长期随访的RCT来进行验证。

Objective To assess the effectiveness and safety of gabapentin treatment of uremic pruritus. Methods We searched MEDLINE,EMbase,the Cochrane Renal Group＇s Specialized Register and CENTRAL,CNKI,VIP,Wan Fang Data and CBM database,collecting gabapentin treatment of uremic pruritus related randomized controlled trials（ RCT） 。After the two investigators independently screened the literature,extracted data and evaluated methodological quality of included studies then data was analyzed statistically using Rev Man 5. 2 software. Results The final results included 10 RCT,a total of 519 cases of patients,followed up for 1 to 12 weeks,which contain three English letters,7 Chinese letters. Meta-analysis showed： Gabapentin treatment of uremic pruritus was better than placebo / control group and antihistamines Group[SMD：- 4. 91,95% CI（- 6. 96,- 2. 86）,P 0. 00001]。Some studies compared the hemoglobin,parathyroid hormone,calcium,phosphorus and other laboratory parameters before and after the test,and showed no significant change. Gabapentin group reported 41 cases of adverse reactions,mostly mildmoderate nausea,dizziness,drowsiness,fatigue,usually taking the symptoms disappeared after the first week. there was no reports of serious adverse reactions. The control group（ placebo / control group and antihistamines group） reported six cases of adverse reactions,mostly mild-moderate nausea,dizziness,which has no special treatment. All the studies did not report deaths. Conclusion The current evidence suggests that short-term taking gabapentin itchy can improve uremic patients of skin condition,but it is restricted by the quantity and quality in the study,this study still need to carry out more large sample,high-quality,long-term followup to verify RCT.