活性维生素D对慢性肾脏疾病微炎症及肾功能疗效的Meta-分析

Meta-analysis of active vitamin D on microinflammation and renal function in patients with chronic kidney disease

目的探讨活性维生素D用于慢性肾脏疾病的治疗效果。方法检索Ovide Medline、CINAHL、Embase、Cochrane Central Register of Controlled Trials、中国学术期刊全文数据库(CNKI)、中国生物医学文献数据库(CBM)、万方数据库(Wangfang)和维普中文科技期刊数据库(VIP)等数据库,收集活性维生素D用于慢性肾脏疾病治疗的临床随机对照研究(RCT),检索年限均为2005年1月-2018年6月。采用Revman 5.3软件进行数据分析。结果共纳入18个RCTs,Jadad量表评分均≥2分。治疗后试验组超敏C-反应蛋白(hs-CRP)[MD=-1.10,95%CI(-1.72,-0.49),P<0.05]、白介素6 (IL-6)[MD=-23.77, 95%CI (-38.32,-9.22), P<0.05]与肿瘤坏死因子-α(TNF-α)[MD=-120.28,95%CI (-177.02,-63.54),P<0.05]降低幅度均高于对照组,两组比较差异显著(P<0.05),试验组血肌酐(SCr)、24h尿蛋白定量与血尿素氮(BUN)降低幅度均高于对照组(P<0.05)。试验组血清甲状旁腺激素水平[MD=-10.87,95%CI(-13.44,8.30),P<0.05]降低幅度高于对照组。结论活性维生素D可降低CKD患者微炎症,改善患者肾功能,预防继发性甲状旁腺功能亢进。

Objective To investigate the therapeutic effect of active vitamin D on chronic kidney disease.Methods Electronic databases,including Ovide Medline,CINAHL,Embase,Cochrane Central Register of Controlled Trials,CNKI and wanfang were searched,Randomized controlled trials(RCTs) which met the inclusion criteria were collected,search period from January 2005 to June 2018.Indicators of inflammation,renal function,parathyroid hormone(PTH) were extracted.Data analysis was performed using Revman 5.3 software.Results A total of 15 18 clinical RCTs were included,of which the Jadad scale scores were ≥ 2 points.After treatment,the reduction of high-sensitivity C-reactive protein(hs-CRP) [MD=-1.10,95%CI(-1.72,--0.49),P<0.05],interleukin-6(IL-6) [MD=-23.77,95%CI(-38.32,-9.22),P<0.05] and tumor necrosis factor-α(TNF-α) [MD=-120.28,95%CI(-177.02,-63.54),P<0.05] in the experimental group were higher than those in the control group,and the difference between the two groups was significant(P<0.05).Reduction of 24 h urine protein and blood BUN in the experimental group were higher than the control group(P<0.05).The reduction of serum PTH [MD=-10.87,95%CI(-13.44,8.30),P<0.05] in the experimental group was higher than that in the control group.Conclusion Active vitamin D can reduce microinflammation in patients with CKD,improve renal function and prevent secondary hyperparathyroidism.