别嘌呤醇联合水化对冠状动脉介入术后造影剂肾病预防作用的Meta分析

Meta-analysis of allopurinol combined with hydration on the prevention of contrast agent nephropathy after coronary intervention

目的造影剂肾病是应用造影剂后引起的急性肾功能损伤,别嘌呤醇联合水化能否有效减少冠状动脉(冠脉)介入术后造影剂肾病的发生率。系统评价别嘌呤醇联合水化能否减少冠脉介入后造影剂肾病的发病率。方法计算机检索PubMed、EMbase、The Cochrane Library(2018年7期)、中国生物医学文献网、万方和中国知网等数据库,查找冠脉介入患者应用造影剂前采用别嘌呤醇联合水化预处理的随机对照试验(RCT),检索时限均从建库至2018年7月。由2位评价员按纳入与排除标准独立筛选文献、提取数据并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果共纳入5个RCT,包括699例患者,其中别嘌呤醇联合水化组349例,对照组单纯水化组350例。Meta分析结果显示:别嘌呤醇联合水化处理组造影剂肾病的发生率显著低于对照单纯水化组(RR=0.30,95%CI:0.10~0.88,P=0.03)。别嘌呤醇联合水化处理组术后肌酐、尿素氮和尿酸显著低于对照单纯水化组(SMD=-0.41,95%CI:-0.58^-0.25,P<0.0001;SMD=-0.40,95%CI:-0.60^-0.20,P<0.0001;SMD=-0.31,95%CI:-0.52^-0.11,P<0.0001)。别嘌呤醇联合水化处理组肌酐清除率显著高于对照单纯水化组(SMD=0.48,95%CI:0.21~0.75,P=0.0005)。结论别嘌呤醇联合水化处理较单纯水化显著减少造影剂肾病的发生率,并且减少肾功能不全患者应用造影剂后肾功能的损伤。受纳入研究数量和质量限制,上述结论仍需开展更多高质量的RCT加以验证。

Objectives Contrast-induced nephropathy(CIN)is acute renal insufficiency after using contrast agent.The results of allopurinol with hydration in the CIN prevention after coronary angiography(CAG)and percutaneous coronary intervention(PCI)are not identical.Meta-analysis of randomized controlled trial(RCT)was to evaluate the role of allopurinol with hydration on CIN in patients undergoing contrast exposure.Methods Two investigators independently searched MEDLINE,EMBASE,the Cochrane Controlled Trials Registry,the China Wanfang Data,the China Biological Medicine Database and the China National Knowledge Infrastructure databases for RCT comparing allopurinol wwith hydration versus conventional hydration therapy on preventing CIN in patients from their inception to July 31,2018.The included RCT were screened,extracted and reviewed on bias risk by 2 reviewers according to inclusion and exclusion criteria,and given Meta-analysis by using RevMan 5.3 software.Results A total of 5 RCTs with a total of 699 patients were included,including 349 in the allopurinol-hydration group and 350 in the control-only hydration group.Meta analysis results showed that the incidence of contrast nephropathy in the allopurinol and hydration treatment group was significantly lower than that in the control alone hydration group(RR=0.30,95%CI:0.10~0.88,P=0.03).The creatinine,urea nitrogen and uric acid in the allopurinol combined with hydration treatment group were significantly lower than those in the control alone hydration group(SMD=-0.41,95%CI:-0.58^-0.25,P<0.0001;SMD=-0.40,95%CI:-0.60^-0.20,P<0.0001;SMD=-0.31,95%CI:-0.52^-0.11,P<0.0001).The creatinine clearance rate of the allopurinol combined with hydration treatment group was significantly higher than that of the control alone hydration group(SMD=0.48,95%CI:0.21~0.75,P=0.0005).Conclusion Compared with hydration alone,allopurinol combined with hydration can reduce the incidence of contrast-induced nephropathy,and reduce renal function damage in patients with renal insufficiency after application of contrast.Limited by the number and quality of included studies,the above conclusions need to be verified by more high-quality RCTs.