烟酰胺治疗维持性透析患者高磷血症的安全性及有效性Meta分析

Efficacy and safety of nicotinamide for the treatment of hyperphosphatemia in patients undergoing maintenance hemodialysis: A Meta-Analysis

目的评价烟酰胺治疗维持性透析患者高磷血症的安全性及有效性。方法在中国期刊全文数据库(CNKI)、万方数据库、维普期刊数据库、Pub Med四个数据库中检索使用烟酰胺治疗维持性透析患者高磷血症的随机对照临床试验文献,经过质量评估和数据提取,对符合标准的研究用Rev Man5.2软件进行Meta分析。结果 5项研究中共172名维持性血液透析患者入选,Meta分析结果显示,烟酰胺组患者血清磷水平、钙磷乘积明显低于对照组{[SMD=-1.02,95%CI(-1.8,-0.23),P<0.05]、[WMD=-0.86,95%CI(-1.53,-0.20),P=0.01]}。两组患者血清钙水平、甲状旁腺激素水平比较差异无统计学意义{[SMD=0.23,95%CI(-0.08,0.54),P=0.14]、[WMD=-0.54,95%CI(-1.27^-0.20),P=0.15]}。烟酰胺组患者易发生皮肤潮红、恶心、血小板减少等不良事件,停药后症状消失,无需特殊处理,不良反应发生率与对照组相比差异无统计学意义。结论烟酰胺治疗能有效改善维持性血液透析患者高磷血症生化指标,临床使用安全有效。

Objective To evaluate the safety and efficacy of nicotinamide for the treatment of hyperphosphatemia in patients undergoing maintenance hemodialysis. Methods According to the collaborative search strategy,CNKI,Wanfang Database,Weipu Database,Pub Med were searched for literature about clinical trials on nicotinamide treatment for hyperphosphatemia in patients undergoing maintenance hemodialysis. After quality assessment and data extraction,Meta- analysis was conducted by Rev Man 5. 0.Results A total of 172 maintenance dialysis patients in the 5 reports were analyzed. Meta-analysis showed that the levels of serum phosphorus and calcium-phosphorus in nicotinamide group significantly lower than that in control group { [SMD =- 1. 02,95% CI（- 1. 8,- 0. 23）,P 〈 0. 05]and [WMD =- 0. 86,95% CI（- 1. 53,- 0. 20）,P = 0. 01]}. There was no statistical difference in the levels of serum calcium and parathyroid hormone between two groups { [SMD = 0. 23,95% CI（- 0. 08,0. 54）,P = 0. 14]and [WMD =- 0. 54,95% CI（- 1. 27 ^- 0. 20）,P = 0. 15]}. Skin flushing,nausea,thrombocytopenia and other adverse events were found in patients treated with nicotinamide,but the symptoms disappear after drug withdrawal,the adverse events in two groups had no statistical significance. Conclusions Nicotinamide could effectively improve serum biochemical indexes in maintenance dialysis patients with hyperphosphatemia,and it is safe.