螺内酯对皮质醇水平的影响

The Effect of Spironolactone on Cortisol Level

目的系统评价螺内酯对皮质醇水平的影响。方法在国内外常用数据库检索发表至2020年12月,有关螺内酯对皮质醇水平影响的临床研究。根据纳入和排除标准筛选文献,评价文献质量,提取数据,采用Stata 12.0软件进行Meta分析,并检测偏倚和敏感性。结果纳入18篇文献。对纳入的螺内酯影响血浆皮质醇水平研究行亚组Meta分析,5篇RCT研究SMD=0.59,95%CI:0.39~0.78,P<0.001,5篇对照组研究SMD=0.55,95%CI:0.16~0.94,P=0.005,5篇自身对照研究SMD=0.37,95%CI:-0.07~0.81,P=0.097,显示螺内酯可升高血浆皮质醇水平。因相关文献较少,尚不能得到螺内酯对唾液皮质醇和24 h尿游离皮质醇影响的可靠结果。结论长期小剂量及短期大剂量口服螺内酯可使血浆皮质醇水平升高。临床中应关注盐皮质激素受体(MR)拮抗剂对皮质醇水平的影响及因此可能对机体产生的负面效应。

Objective To systematically evaluate the effect of Spironolactone on Cortisol level.Methods The clinical studies concerning the effect of Spironolactone on Cortisol level and published before December 2020 were searched in the commonly used databases.Based on inclusion and exclusion criteria,appropriate literatures were included and evaluated.The Meta-analysis was conducted by Stata 12.0 software on the study data from these literatures.The publication bias and sensitivity of results were also analyzed.Results A total of 18 studies were included.Subgroup meta-analysis was performed on the studies concerning the effect of Spironolactone on plasma Cortisol level,of which SMD=0.59,95%CI:0.39~0.78 and P<0.001 in 5 RCT studies,SMD=0.55,95%CI:0.16~0.94 and P=0.005 in 5 control studies,SMD=0.37,95%CI:-0.07~0.81 and P=0.097 in 5 self-controlled studies,showing that Spironolactone could increase plasma Cortisol level.The effects of Spironolactone on salivary Cortisol and 24-hour urine free Cortisol were uncertain for the fewer relevant studies.Conclusion Long-term low-dose or short-term high-dose oral Spironolactone can increase plasma Cortisol level.The influence of mineralocorticoid receptor(MR)antagonists on Cortisol level and its possible negative effect on the body should be concerned.