双膦酸盐类药物对慢性肾脏病患者血管钙化疗效的Meta分析

Effect of diphosphonates on vascular calcification in chronic kidney disease patients:a meta-analysis

目的系统评价双膦酸盐对慢性肾脏病(chronic kidney disease,CKD)患者血管钙化的影响。方法检索PubMed、Embase、Cochrane图书馆、中国知网和万方数据库,时间从建库到2020年9月,纳入了双膦酸盐治疗慢性肾脏病患者血管钙化相关的随机对照试验(randomized controlled trial,RCT)和观察性研究。按照纳入和排除标准对文献进行筛选,并进行质量评价和数据提取。运用Review Manager 5.4软件进行Meta分析。结果最终纳入了5项RCT和1项队列研究,共222名患者。Meta分析结果显示,双膦酸盐组与对照组在缓解CKD患者血管钙化(SMD=-0.28,95%CI:-0.58~0.01,P=0.06)、主动脉钙化(SMD=-0.32,95%CI:-0.70~0.05,P=0.09)和冠状动脉钙化(SMD=-0.22,95%CI:-0.70~0.27,P=0.38)的程度差异上均不具有统计学意义。依替膦酸盐可显著降低CKD患者的血管钙化(SMD=-0.46,95%CI:-0.86~-0.05,P=0.03)。双膦酸盐的应用对患者血清钙(SMD=0.28,95%CI:-0.29~0.84,P=0.34)、磷(SMD=-0.06,95%CI:-0.28~0.17,P=0.63)及甲状旁腺激素(parathyroid hormone,PTH)(SMD=0.20,95%CI:-0.84~1.24,P=0.70)水平均无显著影响。结论双膦酸盐类药物对CKD患者血管钙化具有一定的疗效,依替膦酸盐是目前最具治疗潜力的一类双膦酸盐。

Objective To evaluate the effects of diphosphonates on vascular calcification in chronic kidney disease(CKD)patients.Methods PubMed,Embase,Cochrane library,CNKI and Wanfang databases up to September,2020 were searched for the randomized controlled trials(RCT)and observational studies on the treatment of diphosphonates for vascular calcification in CKD patients.Pieces of literature were screened according to the inclusion and exclusion criteria and quality.Data extracted from the literature were analyzed using Review Manager software version 5.4.Results A total of 5 RCTs and 1 cohort study including 222 patients were enrolled.No significant differences were found between diphosphonates group and control group in terms of the progress of vascular calcification(P=0.06),aortic artery calcification(P=0.09)and coronary artery calcification(P=0.38)in CKD patients.Etidronate could significantly reduce vascular calcification in CKD patients(P=0.03).The treatment of diphosphonates had no significant changes in serum calcium(P=0.34),phosphate(P=0.63),and parathyroid hormone(PTH)(P=0.70)in CKD patients.Conclusion Diphosphonates have an effect on vascular calcification in CKD patients,and etidronate is the most promising therapeutic agent.