腺苷受体拮抗剂预防造影剂肾病对照研究的Meta分析

Meta Analysis of Adenosine Antagonists in the Prevention of Contrast Induced Nephropathy

目的:应用Meta分析的方法评价腺苷受体拮抗剂预防造影剂肾病(CIN)的价值。方法:检索腺苷受体拮抗剂预防造影剂肾病的相关文献,提取符合纳入标准的数据,运用Rev Man 5.0软件进行统计分析。结果:本研究最终纳入11个随机对照试验进行Meta分析,共1 063例患者,其中腺苷受体拮抗剂组患者526例,对照组537例。使用腺苷受体拮抗剂组的患者CIN发生率明显低于对照组,差异有统计学意义(RR=0.61,95%CI:0.42~0.91;P=0.01)。在术后Scr水平腺苷受体拮抗剂组相对于对照组并没有显著区别(P=0.46)。亚组分析腺苷受体拮抗剂剂量> 400 mg时腺苷受体拮抗剂组的患者CIN发生率明显低于对照组,差异有统计学意义(RR=0.45,95%CI:0.22~0.89;P=0.02);造影剂剂量> 100 mL时腺苷受体拮抗剂组的患者CIN发生率明显低于对照组,差异有统计学意义(RR=0.49,95%CI:0.33~0.75;P=0.001)。结论:腺苷受体拮抗剂作用于碘造影剂术后患者能降低CIN发生的风险。在腺苷受体拮抗剂剂量> 400 mg、造影剂剂量> 100 mL时,腺苷受体拮抗剂倾向于表现出更佳的CIN预防效果。上述结果还需要更多大样本及多中心的对照试验加以验证。

Objective: Evaluation of adenosine antagonists in the prevention of contrast induced nephropathy by Meta analysis. Methods: To search the relevant literature of adenosine antagonists in the prevention of contrast induced nephropathy, extract the data that meet the inclusion criteria, and use Revman 5.0 software for statistical analysis. Results: In this study, 11 randomized controlled trials were included for Meta analysis. There were 1063 patients in total, 526 in the adenosine antagonist group and 537 in the control group. The incidence of CIN in the adenosine antagonist group was significantly lower than that in the control group(RR=0.61, 95% CI: 0.42~0.91;P=0.01). The difference was statistically significant(RR=0.61, 95% CI: 0.42~0.91;P=0.01).There was no significant difference between the two groups(P=0.46). When the dose of adenosine antagonist was more than 400 mg, the incidence of CIN in the adenosine antagonist group was significantly lower than that in the control group(RR=0.45, 95% CI: 0.22~0.89;P=0.02). When the dose of contrast agent was more than 100 ml, the incidence of CIN in the adenosine antagonist group was significantly lower than that in the control group Meaning(RR=0.49, 95% CI: 0.33~0.75;P=0.001). Conclusion: adenosine antagonists can reduce the risk of CIN in patients after iodine contrast agent operation. When the dose of adenosine antagonist is more than 400 mg and the dose of contrast agent is more than 100 ml, adenosine antagonist tends to show better CIN prevention effect. The above results need more large samples and multicenter control tests to verify.